Provider Demographics
NPI:1043351281
Name:NORTHEASTERN PENNSYLVANIA CARDIOLOGY ASSOCIATES LLP
Entity Type:Organization
Organization Name:NORTHEASTERN PENNSYLVANIA CARDIOLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:570-823-1111
Mailing Address - Street 1:667 N RIVER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1013
Mailing Address - Country:US
Mailing Address - Phone:570-823-1111
Mailing Address - Fax:570-824-9044
Practice Address - Street 1:667 N RIVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1013
Practice Address - Country:US
Practice Address - Phone:570-823-1111
Practice Address - Fax:570-824-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1722207Medicaid
PA365638OtherHIGMARK BLUE SHIELD
PA365638OtherHIGMARK BLUE SHIELD