Provider Demographics
NPI:1083911242
Name:NORTHEASTERN PENNSYLVANIA HEALTH CORPORATION
Entity Type:Organization
Organization Name:NORTHEASTERN PENNSYLVANIA HEALTH CORPORATION
Other - Org Name:OCCUPATIONAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-501-8293
Mailing Address - Street 1:50 MOISEY DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9297
Mailing Address - Country:US
Mailing Address - Phone:570-501-6800
Mailing Address - Fax:570-501-6805
Practice Address - Street 1:700 E BROAD ST
Practice Address - Street 2:PATIENT ACCOUNTS
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6835
Practice Address - Country:US
Practice Address - Phone:570-501-4700
Practice Address - Fax:570-501-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017859E2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1780748152OtherNORTHEASTERN PENNSYLVANIA HEALTH CORPORATION NPI