Provider Demographics
NPI:1083657118
Name:HERSHEY KIDNEY SPECIALISTS INC
Entity Type:Organization
Organization Name:HERSHEY KIDNEY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-526-4474
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0517
Mailing Address - Country:US
Mailing Address - Phone:570-450-6200
Mailing Address - Fax:570-450-6207
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:SUITE 240
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-526-4474
Practice Address - Fax:717-526-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043430E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB74662Medicare UPIN
PAP95891Medicare UPIN
PA084392MC6Medicare PIN
PA072246MC6Medicare PIN
PA429579MC6Medicare PIN
PA013139Medicare PIN
PAF56728Medicare UPIN
PA050953MC6Medicare PIN
PA128152MC6Medicare PIN
PAQ26130Medicare UPIN