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NPI Code Detail

MEDICARE: NORTHERN TIER GASTROENTEROLOGY INC

MEDICARE: NORTHERN TIER GASTROENTEROLOGY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician
2367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1578906483
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN TIER GASTROENTEROLOGY INC
Provider Business Mailing Address
First Line : 681 SCRANTON CARBONDALE HWY
Second Line :
City : EYNON
State : PA
Zip : 18403-1022
Country : US
Telephone Number : 570-876-5900
Fax Number : 570-876-5300
Provider Business Practice Location Address
First Line : 681 SCRANTON CARBONDALE HWY
Second Line :
City : EYNON
State : PA
Zip : 18403-1022
Country : US
Telephone Number : 570-876-5900
Fax Number : 570-876-5300
Authorized Official
Title or Position : PRESIDEN T
Name : NAYAN C SHAH
Credential : MD
Telephone Number : 570-876-5900
Provider Enumeration Date : 04/10/2013
Last Update Date : 04/10/2013

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Directions to “NORTHERN TIER GASTROENTEROLOGY INC ” Practice Location

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