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General NPI Number Information
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NPI Number | 1104929470
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN OCCUPATIONAL MEDICINE & REHABILITATION CENTER, P.C.
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 769 KEYSTONE INDUSTRIAL PARK
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City | DUNMORE
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State | PA
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Zip | 18512
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Country | US
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Telephone | 570-341-7777
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Fax | 570-341-7789
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Provider Business Mailing Address
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Address Line | 769 KEYSTONE INDUSTRIAL PARK
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City | DUNMORE
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State | PA
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Zip | 18512
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Country | US
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Telephone | 570-341-7777
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Fax | 570-341-7789
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK J. FRICCHIONE
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Credential | M.D.
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Telephone | 570-341-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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