Provider Demographics
NPI:1558339143
Name:GEYFMAN, VITALY (DO)
Entity Type:Individual
Prefix:DR
First Name:VITALY
Middle Name:
Last Name:GEYFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 JEFFERSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1624
Mailing Address - Country:US
Mailing Address - Phone:570-342-1776
Mailing Address - Fax:570-963-0663
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-342-1776
Practice Address - Fax:570-963-0663
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012775207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101176511Medicaid
I23240Medicare UPIN