1720419591 NPI number — MATERNAL & FAMILY HEALTH SERVICES INC

Table of content: MR. FREDDY DUARTE LAU M.D. (NPI 1598226722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720419591 NPI number — MATERNAL & FAMILY HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATERNAL & FAMILY HEALTH SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720419591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PUBLIC SQ
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18701-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-826-1777
Provider Business Mailing Address Fax Number:
570-823-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-5550
Provider Business Practice Location Address Fax Number:
570-961-3844
Provider Enumeration Date:
12/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SAXTON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
COX
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
570-826-1777

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN000965 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019462460007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027974660004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028977840002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019462460004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007678420044 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007678420040 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027974660001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1029006920002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019462370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com