Provider Demographics
NPI:1831390343
Name:EARLY PSYCHIATRIC & COUNSELING SERVICE, P.C
Entity type:Organization
Organization Name:EARLY PSYCHIATRIC & COUNSELING SERVICE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CHIEF PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:UR
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-454-2545
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-0100
Mailing Address - Country:US
Mailing Address - Phone:570-454-2545
Mailing Address - Fax:570-454-6191
Practice Address - Street 1:116 N 5TH ST
Practice Address - Street 2:
Practice Address - City:W HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-3946
Practice Address - Country:US
Practice Address - Phone:570-454-2545
Practice Address - Fax:570-454-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053911-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015129990009Medicaid
PAG00397Medicare UPIN
PA110795Medicare PIN