Basic Information
| Provider Information | |||||||||
| NPI: | 1386876514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRG CENTRAL PA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152300060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129375726 | ||||||||
| FaxNumber: | 4129375706 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E 16TH ST | ||||||||
| Address2: | |||||||||
| City: | BERWICK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186032316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707595000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2009 | ||||||||
| LastUpdateDate: | 08/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | PISULA | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4125510011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.