Provider Demographics
NPI:1538111786
Name:MICHAEL S IMBROGNO MD PC
Entity Type:Organization
Organization Name:MICHAEL S IMBROGNO MD PC
Other - Org Name:WYOMING VALLEY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:IMBROGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-822-7070
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18703-1736
Mailing Address - Country:US
Mailing Address - Phone:570-822-7070
Mailing Address - Fax:570-822-9468
Practice Address - Street 1:3 OAK CTR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7338
Practice Address - Country:US
Practice Address - Phone:570-822-7070
Practice Address - Fax:570-822-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 037262 E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty