Provider Demographics
NPI:1679752331
Name:POCONO ORTHOPEDIC CONSULTANTS, INC
Entity Type:Organization
Organization Name:POCONO ORTHOPEDIC CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-424-5180
Mailing Address - Street 1:500 PLAZA CT STE D
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8262
Mailing Address - Country:US
Mailing Address - Phone:570-424-5180
Mailing Address - Fax:
Practice Address - Street 1:500 PLAZA CT STE D
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-424-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114615Medicare PIN