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General NPI Number Information
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NPI Number | 1720124811
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Entity Type | Organization
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Legal Business Name | EKG ASSOCIATES OF WYOMING VALLEY LLP
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 575 N RIVER ST
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City | WILKES BARRE
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State | PA
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Zip | 18764-0999
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Country | US
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Telephone | 570-288-5441
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Fax | 570-288-5842
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Provider Business Mailing Address
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Address Line | 610 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3702
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Country | US
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Telephone | 570-288-5441
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Fax | 570-288-5842
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ELLIS
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Credential | MD
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Telephone | 570-823-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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