Provider Demographics
NPI:1518040179
Name:HUSKY RESEARCH CORPORATION INC
Entity Type:Organization
Organization Name:HUSKY RESEARCH CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-389-4015
Mailing Address - Street 1:400 E 2ND ST
Mailing Address - Street 2:BLOOMSBURG UNIVERSITY CENTENNIAL HALL
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1301
Mailing Address - Country:US
Mailing Address - Phone:570-389-5380
Mailing Address - Fax:570-389-5022
Practice Address - Street 1:400 E 2ND ST
Practice Address - Street 2:BLOOMSBURG UNIVERSITY CENTENNIAL HALL
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1301
Practice Address - Country:US
Practice Address - Phone:570-389-5380
Practice Address - Fax:570-389-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD00617231H00000X
PAD0061700231HA2500X, 237600000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50218OtherGEISINGER HEALTH PLAN
PA079130Medicare ID - Type Unspecified