Provider Demographics
NPI:1154855898
Name:ENDOCRINOLOGY CLINIC P.C.
Entity Type:Organization
Organization Name:ENDOCRINOLOGY CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYSE
Authorized Official - Middle Name:KARCA
Authorized Official - Last Name:MOHYUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-455-0100
Mailing Address - Street 1:1090 N CHURCH ST
Mailing Address - Street 2:200 HAZLETON PROFESSIONAL PLAZA
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1480
Mailing Address - Country:US
Mailing Address - Phone:570-455-0100
Mailing Address - Fax:570-455-0177
Practice Address - Street 1:1090 N CHURCH ST
Practice Address - Street 2:200 HAZLETON PROFESSIONAL PLAZA
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1480
Practice Address - Country:US
Practice Address - Phone:570-455-0100
Practice Address - Fax:570-455-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438286207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty