Provider Demographics
NPI:1720050487
Name:PITTSTON MEDICAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:PITTSTON MEDICAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-655-9107
Mailing Address - Street 1:1099 S TOWNSHIP BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3247
Mailing Address - Country:US
Mailing Address - Phone:570-655-1495
Mailing Address - Fax:570-655-6945
Practice Address - Street 1:1099 S TOWNSHIP BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3247
Practice Address - Country:US
Practice Address - Phone:570-655-1495
Practice Address - Fax:570-655-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000417291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA308237OtherHIGHMARK BLUE CROSS/BLUE SHIELD
PA308237OtherFIRST PRIORITY LIFE INS C
PA308237OtherFIRST PRIORITY LIFE INS C
PA308237OtherHIGHMARK BLUE CROSS/BLUE SHIELD