| Rd Of Nepa Llc | |
|
532 Main St Ste 3 Moosic PA 18507-1001 | |
| (570) 457-2464 | |
| (570) 457-2492 |
| Full Name | Rd Of Nepa Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 532 Main St Ste 3, Moosic, Pennsylvania |
| Authorized Official Name and Position | Leanna Tabatabaie (OWNER) |
| Authorized Official Contact | 5704572464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rd Of Nepa Llc 532 Main St Ste 3 Moosic PA 18507-1001 Ph: (570) 457-2464 | Rd Of Nepa Llc 532 Main St Ste 3 Moosic PA 18507-1001 Ph: (570) 457-2464 |
| NPI Number | 1821579913 |
|---|---|
| Provider Enumeration Date | 08/27/2018 |
| Last Update Date | 09/08/2022 |
| Medicare PECOS PAC ID | 3274885611 |
|---|---|
| Medicare Enrollment ID | O20181011002447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821579913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Pennsylvania) | Primary |
| Provider Name | Leanna Tabatabaie |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1457854150 PECOS PAC ID: 4183976525 Enrollment ID: I20181011002503 |
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