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General NPI Number Information
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NPI Number | 1417148289
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Entity Type | Organization
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Legal Business Name | KEYSTONE NEUROSENSORY CENTERS,LLC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 250 PIERCE ST SUITE 317
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City | KINGSTON
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State | PA
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Zip | 18704-5149
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Country | US
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Telephone | 570-763-0054
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Fax | 570-763-0056
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Provider Business Mailing Address
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Address Line | 250 PIERCE ST SUITE 317
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City | KINGSTON
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State | PA
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Zip | 18704-5149
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Country | US
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Telephone | 570-763-0054
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Fax | 570-763-0056
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANE HABERKERN
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Credential |
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Telephone | 570-763-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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