Basic Information
Provider Information
NPI: 1396848636
EntityType: 2
ReplacementNPI:  
OrganizationName: POCONO MED-PEDS ASSOC PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 400 PLAZA COURT
Address2: SUITE A
City: E STROUDSBURG
State: PA
PostalCode: 18301
CountryCode: US
TelephoneNumber: 5704221290
FaxNumber: 5704766108
Practice Location
Address1: 200 PLAZA CT STE B
Address2:  
City: E STROUDSBURG
State: PA
PostalCode: 183018259
CountryCode: US
TelephoneNumber: 5704221290
FaxNumber: 5704766108
Other Information
ProviderEnumerationDate: 09/05/2006
LastUpdateDate: 02/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SEDANI
AuthorizedOfficialFirstName: MAYURI
AuthorizedOfficialMiddleName: K
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5704221290
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 02/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XMD062149LPAY193400000X SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
MD062149L01PASTATE LICENSEOTHER


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