Provider Demographics
NPI:1922062991
Name:NORTHEAST EAR, NOSE, & THROAT
Entity Type:Organization
Organization Name:NORTHEAST EAR, NOSE, & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLYN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GERGITS
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:570-387-4368
Mailing Address - Street 1:6850 LOWS RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8708
Mailing Address - Country:US
Mailing Address - Phone:570-387-4368
Mailing Address - Fax:570-387-6344
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8708
Practice Address - Country:US
Practice Address - Phone:570-387-4368
Practice Address - Fax:570-387-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008222L207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS57018Medicare UPIN
PAG78024Medicare UPIN