Healthcare Provider Details

I. General information

NPI: 1447243738
Provider Name (Legal Business Name): WYNTRE BROOK SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 S QUEEN ST LOWER LEVEL
YORK PA
17403-3840
US

IV. Provider business mailing address

1399 S QUEEN ST LOWER LEVEL
YORK PA
17403-3840
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-2921
  • Fax: 717-812-2921
Mailing address:
  • Phone: 717-812-2921
  • Fax: 717-812-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD024908E
License Number StatePA

VIII. Authorized Official

Name: NIKHILESH AGARWAL
Title or Position: DIRECTOR/ACTIVE,ATTENDING
Credential: MD
Phone: 717-812-2921