Provider Demographics
NPI:1740428689
Name:MARK A GONSKY DO
Entity Type:Organization
Organization Name:MARK A GONSKY DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-403-5000
Mailing Address - Street 1:59 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1778
Mailing Address - Country:US
Mailing Address - Phone:570-403-5000
Mailing Address - Fax:570-693-6178
Practice Address - Street 1:111 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1921
Practice Address - Country:US
Practice Address - Phone:570-403-5000
Practice Address - Fax:570-693-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSOO51O5L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty