Provider Demographics
NPI:1760413595
Name:CEDAR EMERGENCY PHYSICIANS INC
Entity Type:Organization
Organization Name:CEDAR EMERGENCY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-501-2692
Mailing Address - Street 1:101 S CHURCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6279
Mailing Address - Country:US
Mailing Address - Phone:570-501-2692
Mailing Address - Fax:570-501-2695
Practice Address - Street 1:101 S CHURCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6279
Practice Address - Country:US
Practice Address - Phone:570-501-2692
Practice Address - Fax:570-501-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007636L261QU0200X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019549630004Medicaid
PA0019549630004Medicaid