Provider Demographics
NPI:1245573302
Name:JUTHANI, BIREN KISHOR (DO)
Entity Type:Individual
Prefix:
First Name:BIREN
Middle Name:KISHOR
Last Name:JUTHANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PLAZA COURT
Mailing Address - Street 2:BUILDING 500 SUITE B
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8262
Mailing Address - Country:US
Mailing Address - Phone:570-426-2301
Mailing Address - Fax:570-426-2306
Practice Address - Street 1:447 PLAZA COURT
Practice Address - Street 2:BUILDING 500 SUITE B
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1830
Practice Address - Country:US
Practice Address - Phone:570-426-2301
Practice Address - Fax:570-426-2306
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0211222086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS021122OtherSTATE LICENSE