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General NPI Number Information
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NPI Number | 1245311067
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Entity Type | Organization
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Legal Business Name | POCONO SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 03/02/2009
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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 | 570-421-5997
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Fax | 570-421-7635
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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 | 570-421-5997
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Fax | 570-421-7635
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Authorized Official
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Title or Position | OWNER
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Name | DR. BORIS PAUL
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Credential | M.D.
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Telephone | 570-421-5997
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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 | MD028193E
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License Number State | PA
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