1891705000 NPI number — ALBERT D. JANERICH, MD

Table of content: (NPI 1891705000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891705000 NPI number — ALBERT D. JANERICH, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERT D. JANERICH, MD
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:
1891705000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 WYOMING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PITTSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18643-2742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-824-4111
Provider Business Mailing Address Fax Number:
570-824-3167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18643-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-4111
Provider Business Practice Location Address Fax Number:
570-824-3167
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JANERICH
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-824-4111

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015473590006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081097 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CG9913 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1145603 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1526634 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 506146 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000074260 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2193450 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 789835 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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