Basic Information
| Provider Information | |||||||||
| NPI: | 1306949649 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | POCONO PULMONARY ASSOC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 PLAZA COURT | ||||||||
| Address2: | SUITE A | ||||||||
| City: | E STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704765864 | ||||||||
| FaxNumber: | 5704766108 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PLAZA COURT | ||||||||
| Address2: | SUITE A | ||||||||
| City: | E STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704226905 | ||||||||
| FaxNumber: | 5704766108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | SEDANI | ||||||||
| AuthorizedOfficialFirstName: | KHEMRAJ | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5704765864 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.