Provider Demographics
NPI:1356751580
Name:LYCOMING PHYSICAL MEDICINE, PC
Entity type:Organization
Organization Name:LYCOMING PHYSICAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-916-4897
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-916-4897
Mailing Address - Fax:570-278-1121
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-916-4897
Practice Address - Fax:570-278-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies