Provider Demographics
NPI:1336364538
Name:PACE, JEFFREY (LPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1240
Mailing Address - Country:US
Mailing Address - Phone:570-675-8151
Mailing Address - Fax:570-675-7524
Practice Address - Street 1:201 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1240
Practice Address - Country:US
Practice Address - Phone:570-675-8151
Practice Address - Fax:570-675-7524
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005230L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist