| Scranton Temple Residency Program Faculty Services | |
|
640 Madison Ave Scranton PA 18510-1624 | |
| (570) 941-0630 | |
| (570) 941-0648 |
| Full Name | Scranton Temple Residency Program Faculty Services |
|---|---|
| Speciality | Internal Medicine |
| Location | 640 Madison Ave, Scranton, Pennsylvania |
| Authorized Official Name and Position | Elisoro Primero (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5709410630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Scranton Temple Residency Program Faculty Services 746 Jefferson Ave Scranton PA 18510-1624 Ph: (570) 343-2383 | Scranton Temple Residency Program Faculty Services 640 Madison Ave Scranton PA 18510-1624 Ph: (570) 941-0630 |
| NPI Number | 1932195492 |
|---|---|
| Provider Enumeration Date | 09/21/2005 |
| Last Update Date | 07/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932195492 | NPI | - | NPPES |
| 001508252 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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