Provider Demographics
NPI:1275011660
Name:BLONDEK CENTER FOR PEDIATRIC HEALTH & WELLNESS PC
Entity Type:Organization
Organization Name:BLONDEK CENTER FOR PEDIATRIC HEALTH & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT570
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLONDEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-466-9747
Mailing Address - Street 1:247 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1641
Mailing Address - Country:US
Mailing Address - Phone:570-382-3665
Mailing Address - Fax:570-483-4137
Practice Address - Street 1:247 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-382-3665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty