Provider Demographics
NPI:1821272147
Name:BOBECK MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BOBECK MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:BOBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-822-6916
Mailing Address - Street 1:892 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR NOTCH
Mailing Address - State:PA
Mailing Address - Zip Code:18706-2015
Mailing Address - Country:US
Mailing Address - Phone:570-822-6916
Mailing Address - Fax:570-824-6936
Practice Address - Street 1:892 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUGAR NOTCH
Practice Address - State:PA
Practice Address - Zip Code:18706-2015
Practice Address - Country:US
Practice Address - Phone:570-822-6916
Practice Address - Fax:570-824-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036890E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty