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General NPI Number Information
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NPI Number | 1578895538
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PRACTICES OF NORTHEASTERN PA
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 27B WOODLANDS DR
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City | WAYMART
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State | PA
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Zip | 18472-9366
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Country | US
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Telephone | 570-448-9550
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Fax | 570-488-9553
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Provider Business Mailing Address
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Address Line | 1837 FAIR AVE
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City | HONESDALE
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State | PA
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Zip | 18431-2121
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Country | US
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Telephone | 570-488-9550
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Fax | 570-488-9553
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERT MORTON
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Credential | MD
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Telephone | 570-253-5838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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