Provider Demographics
NPI:1578542403
Name:PROFESSIONAL ANESTHESIA PROVIDERS, PC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA PROVIDERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROMANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:570-696-3330
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0587
Mailing Address - Country:US
Mailing Address - Phone:570-331-0880
Mailing Address - Fax:570-331-0220
Practice Address - Street 1:974 KASKO RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-9776
Practice Address - Country:US
Practice Address - Phone:570-331-0880
Practice Address - Fax:570-331-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025286Medicare ID - Type Unspecified