Provider Demographics
NPI:1396837035
Name:GREENTOWN MEDICAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:GREENTOWN MEDICAL ASSOCIATES P.C.
Other - Org Name:GREENTOWN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-676-5660
Mailing Address - Street 1:1405 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510
Mailing Address - Country:US
Mailing Address - Phone:570-342-8199
Mailing Address - Fax:570-342-6871
Practice Address - Street 1:1623 ROUTE 507
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426
Practice Address - Country:US
Practice Address - Phone:570-676-5660
Practice Address - Fax:570-676-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040950L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD7205OtherMEDICARE RAILROAD
0781169000OtherPERSONAL CHOICE
PA29514OtherHEALTH AMERICA
E1FKOtherGEISINGER
PA0011471600006Medicaid
PAP2804767OtherOXFORD
PA001425OtherFIRST PRIORITY HEALTH
PA005756OtherAETNA HMO
PA644536OtherBLUESHIELD
644536PAOtherANTHEM BLUE SHIELD
PA29514OtherHEALTH AMERICA
644536PAOtherANTHEM BLUE SHIELD
PAP2804767OtherOXFORD
0781169000OtherPERSONAL CHOICE
PA644536OtherBLUESHIELD