Provider Demographics
NPI:1649395260
Name:447 PLAZA HEART CENTER, INC
Entity Type:Organization
Organization Name:447 PLAZA HEART CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RYLKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-424-9970
Mailing Address - Street 1:373 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9101
Mailing Address - Country:US
Mailing Address - Phone:570-424-9970
Mailing Address - Fax:570-424-2899
Practice Address - Street 1:373 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9101
Practice Address - Country:US
Practice Address - Phone:570-424-9970
Practice Address - Fax:570-424-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039907E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty