Provider Demographics
NPI:1346429982
Name:GEORGE PUEBLITZ, M.D.
Entity Type:Organization
Organization Name:GEORGE PUEBLITZ, M.D.
Other - Org Name:SONIS PUEBLITZ LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUEBLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-539-3119
Mailing Address - Street 1:891 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2839
Mailing Address - Country:US
Mailing Address - Phone:814-539-3119
Mailing Address - Fax:814-539-4137
Practice Address - Street 1:891 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2839
Practice Address - Country:US
Practice Address - Phone:814-539-3119
Practice Address - Fax:814-539-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028921E291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015183660002Medicaid