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General NPI Number Information
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NPI Number | 1114357829
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Entity Type | Organization
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Legal Business Name | MJA HEALTHCARE, PC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 391 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9101
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Country | US
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Telephone | 570-241-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 391 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9101
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Country | US
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Telephone | 570-241-9224
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | MIKAHIL ARTAMONOV
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Credential | MD
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Telephone | 570-241-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD424898
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License Number State | PA
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