Provider Demographics
NPI:1407827470
Name:SCHUYLKILL SURGEONS INC
Entity Type:Organization
Organization Name:SCHUYLKILL SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-429-1000
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:17970-0157
Mailing Address - Country:US
Mailing Address - Phone:570-429-1000
Mailing Address - Fax:570-429-1532
Practice Address - Street 1:278 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:ST. CLAIR
Practice Address - State:PA
Practice Address - Zip Code:17970-0157
Practice Address - Country:US
Practice Address - Phone:570-429-1000
Practice Address - Fax:570-429-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010863310005Medicaid
PA056402Medicare ID - Type Unspecified