Provider Demographics
NPI:1205230109
Name:PENN NEUROMUSCULAR DIAGNOTSICS, LLC
Entity Type:Organization
Organization Name:PENN NEUROMUSCULAR DIAGNOTSICS, LLC
Other - Org Name:PNDX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZAUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-801-8894
Mailing Address - Street 1:9 N 7TH ST
Mailing Address - Street 2:2ND FLOOR, TOWNPLACE VICTORIA
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1880
Mailing Address - Country:US
Mailing Address - Phone:724-801-8894
Mailing Address - Fax:724-465-6032
Practice Address - Street 1:411 THEATRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2838
Practice Address - Country:US
Practice Address - Phone:724-801-8894
Practice Address - Fax:724-465-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207604Medicare PIN