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1164590998 NPI number — POCONO KIDS DENTAL

NPI Number: 1164590998
Health Care Provider/Practitioner: POCONO KIDS DENTAL

Information about “1164590998” NPI (POCONO KIDS DENTAL) exists in 1164590998 in HTML format HTML  |  1164590998 in plain Text format TXT  |  1164590998 in PDF (Portable Document Format) PDF  |  1164590998 in an XML format XML  formats.

NPI Number : 1164590998 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164590998",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "POCONO MEDICAL CENTER",
    "ParentOrgTIN": null,
    "OrgName": "POCONO KIDS DENTAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "206 E BROWN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST STROUDSBURG",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18301-3006",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "570-420-4938",
    "MailingAddressFaxNumber": "570-420-4948",
    "FirstLinePracticeLocationAddress": "175 E BROWN ST STE 114",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAST STROUDSBURG",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "18301-3098",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "570-476-3506",
    "PracticeLocationAddressFaxNumber": "570-421-9014",
    "EnumerationDate": "12/01/2006",
    "LastUpdateDate": "03/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARCHOZZI",
    "AuthorizedOfficialFirstName": "THOMAS",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "SR VP & CFO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "484-862-3943",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QD0000X",
          "TaxonomyName": "Dental Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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