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General NPI Number Information
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NPI Number | 1942211248
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 1860 FAIR AVE SUITE A
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City | HONESDALE
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State | PA
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Zip | 18431-2108
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Country | US
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Telephone | 570-253-3391
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Fax | 570-253-1811
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Provider Business Mailing Address
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Address Line | 1860 FAIR AVE SUITE A
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City | HONESDALE
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State | PA
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Zip | 18431-2108
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Country | US
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Telephone | 570-253-3391
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Fax | 570-253-1811
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID DEWITT REYNOLDS
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Credential | M.D.
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Telephone | 570-253-3991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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