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General NPI Number Information
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NPI Number | 1043351281
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN PENNSYLVANIA CARDIOLOGY ASSOCIATES LLP
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 667 N RIVER ST SUITE 201
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City | PLAINS
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State | PA
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Zip | 18705-1013
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Country | US
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Telephone | 570-823-1111
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Fax | 570-824-9044
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Provider Business Mailing Address
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Address Line | 667 N RIVER ST SUITE 201
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City | PLAINS
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State | PA
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Zip | 18705-1013
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Country | US
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Telephone | 570-823-1111
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Fax | 570-824-9044
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Authorized Official
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Title or Position | PHYSICIAN ADMINISTRATOR
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Name | DR. JOHN H ELLIS IV
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Credential | M.D.
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Telephone | 570-823-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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