Provider Demographics
NPI:1417148289
Name:KEYSTONE NEUROSENSORY CENTERS,LLC
Entity Type:Organization
Organization Name:KEYSTONE NEUROSENSORY CENTERS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABERKERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-763-0054
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-763-0054
Mailing Address - Fax:570-763-0056
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 317
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-763-0054
Practice Address - Fax:570-763-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty