=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356548994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONROE COUNTY GENERAL SURGERY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 04/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 E BROWN ST SUITE 115
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-420-9720
-----------------------------------------------------
Fax | 570-420-9770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 E BROWN ST SUITE 115
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-420-9720
-----------------------------------------------------
Fax | 570-420-9770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. PATRICIA A MARTZ
-----------------------------------------------------
Credential | MD, FACS
-----------------------------------------------------
Telephone | 570-420-9720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 05949L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------