Provider Demographics
NPI:1891824819
Name:INFECTIOUS DISEASE CONS LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-8196
Mailing Address - Street 1:401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2404
Mailing Address - Country:US
Mailing Address - Phone:570-421-8196
Mailing Address - Fax:570-476-6213
Practice Address - Street 1:100 EAGLESMERE CIR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3144
Practice Address - Country:US
Practice Address - Phone:570-421-8196
Practice Address - Fax:570-476-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherFIN