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General NPI Number Information
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NPI Number | 1427993450
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Entity Type | Organization
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Legal Business Name | IWC SERVICES PENNSYLVANIA LLC
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 1205 S 28TH ST
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City | HARRISBURG
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State | PA
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Zip | 17111-1046
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Country | US
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Telephone | 732-451-4318
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Fax |
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Provider Business Mailing Address
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Address Line | 492C CEDAR LN STE 514
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City | TEANECK
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State | NJ
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Zip | 07666-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE LUSAS
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Credential | MD
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Telephone | 203-206-3453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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