Provider Demographics
NPI:1891705000
Name:ALBERT D. JANERICH, MD
Entity Type:Organization
Organization Name:ALBERT D. JANERICH, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JANERICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-824-4111
Mailing Address - Street 1:901 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2742
Mailing Address - Country:US
Mailing Address - Phone:570-824-4111
Mailing Address - Fax:570-824-3167
Practice Address - Street 1:901 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2742
Practice Address - Country:US
Practice Address - Phone:570-824-4111
Practice Address - Fax:570-824-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015473590006Medicaid
PA081097OtherFIRST PRIORITY HEALTH
PACG9913OtherRAILROAD MEDICARE
PA1145603OtherAMERIHEALTH MERCY
PA1526634OtherGATEWAY
PA506146OtherAETNA
PA000000074260OtherUNISON
PA2193450OtherGEISINGER
PA789835OtherBLUE SHIELD
PA0015473590006Medicaid