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General NPI Number Information
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NPI Number | 1457381113
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN SURGICAL SPECIALTY GROUP INC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 190 WELLES ST
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City | FORTY FORT
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State | PA
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Zip | 18704-4968
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Country | US
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Telephone | 570-283-2323
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Fax | 570-283-1290
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Provider Business Mailing Address
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Address Line | 190 WELLES ST
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City | FORTY FORT
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State | PA
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Zip | 18704-4968
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Country | US
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Telephone | 570-283-2323
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Fax | 570-283-1290
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN F KOPEN
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Credential | MD
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Telephone | 570-283-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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