Provider Demographics
NPI:1982891495
Name:EUGENE D HARASYM
Entity Type:Organization
Organization Name:EUGENE D HARASYM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALOWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-961-9947
Mailing Address - Street 1:RR 6 BOX 6239
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9400
Mailing Address - Country:US
Mailing Address - Phone:570-945-7347
Mailing Address - Fax:570-945-5911
Practice Address - Street 1:921 DRINKER TURNPIKE
Practice Address - Street 2:
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-7948
Practice Address - Country:US
Practice Address - Phone:570-842-0945
Practice Address - Fax:570-842-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057861Medicare PIN
PAC32235Medicare UPIN