Provider Demographics
NPI:1629030614
Name:FERENZI MEDICAL PC
Entity Type:Organization
Organization Name:FERENZI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-265-0626
Mailing Address - Street 1:12 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1939
Mailing Address - Country:US
Mailing Address - Phone:570-265-0626
Mailing Address - Fax:
Practice Address - Street 1:12 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1939
Practice Address - Country:US
Practice Address - Phone:570-265-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053803Medicare ID - Type Unspecified