Provider Demographics
NPI:1932785102
Name:NORTHEAST HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:NORTHEAST HEALTH AND WELLNESS
Other - Org Name:NORTHEAST HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-330-0300
Mailing Address - Street 1:4113 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1301
Mailing Address - Country:US
Mailing Address - Phone:570-330-0300
Mailing Address - Fax:
Practice Address - Street 1:4113 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1301
Practice Address - Country:US
Practice Address - Phone:570-330-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty