Provider Demographics
NPI:1932194446
Name:POCONO PEDIATRIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:POCONO PEDIATRIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-476-9788
Mailing Address - Street 1:208 LIFELINE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7566
Mailing Address - Country:US
Mailing Address - Phone:570-476-6700
Mailing Address - Fax:570-476-0735
Practice Address - Street 1:208 LIFELINE RD
Practice Address - Street 2:STE 201
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7566
Practice Address - Country:US
Practice Address - Phone:570-476-6700
Practice Address - Fax:570-476-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty