Basic Information
| Provider Information | |||||||||
| NPI: | 1265428197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RITTENBERGER | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GUTHRIE SQ | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188401625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 5708885858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GUTHRIE SQ DEPT OF | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188401625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708885858 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 301705-01 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD424700 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00262611 | 01 | PA | RR MEDICARE | OTHER | 000000168442 | 01 | PA | UNISON | OTHER | 1624446 | 01 | PA | BCBS PA | OTHER | 1540340 | 01 | PA | GATEWAY | OTHER | 2673763 | 01 | PA | OHIO MEDICAID | OTHER | 701511 | 01 | PA | UPMC | OTHER | 7389515 | 01 | PA | CIGNA | OTHER | 101045510 | 05 | PA | MEDICAID |