Provider Demographics
NPI:1396848636
Name:POCONO MED-PEDS ASSOC PC
Entity Type:Organization
Organization Name:POCONO MED-PEDS ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYURI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SEDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-422-1290
Mailing Address - Street 1:400 PLAZA COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-422-1290
Mailing Address - Fax:570-476-6108
Practice Address - Street 1:200 PLAZA CT STE B
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8259
Practice Address - Country:US
Practice Address - Phone:570-422-1290
Practice Address - Fax:570-476-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062149L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD062149LOtherSTATE LICENSE