Provider Demographics
NPI:1376723767
Name:NEUROSURGICAL SPECIALTIES OF NEPA
Entity Type:Organization
Organization Name:NEUROSURGICAL SPECIALTIES OF NEPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-823-3300
Mailing Address - Street 1:150 MUNDY STREET
Mailing Address - Street 2:MAC 4
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-823-3300
Mailing Address - Fax:570-823-0800
Practice Address - Street 1:150 MUNDY STREET
Practice Address - Street 2:MAC 4
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-823-3300
Practice Address - Fax:570-823-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038409E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013958830003Medicaid
PA0013958830003Medicaid
PAF47242Medicare UPIN
PA0015995420005Medicare PIN