Provider Demographics
NPI:1669361481
Name:KERRICK, NOAH K
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:K
Last Name:KERRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 POPLAR AVE APT Q614
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-2302
Mailing Address - Country:US
Mailing Address - Phone:570-579-6783
Mailing Address - Fax:
Practice Address - Street 1:291 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1346
Practice Address - Country:US
Practice Address - Phone:570-579-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic