Provider Demographics
NPI:1922108315
Name:PENN KIDDER MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PENN KIDDER MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LESITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-722-2125
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-0182
Mailing Address - Country:US
Mailing Address - Phone:570-722-2125
Mailing Address - Fax:570-722-2127
Practice Address - Street 1:2588 STATE ROUTE 903
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210-0182
Practice Address - Country:US
Practice Address - Phone:570-722-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA45326Medicare PIN