Provider Demographics
NPI:1063715639
Name:MEDICAL CENTER OF NORTHEASTERN PA LLC
Entity type:Organization
Organization Name:MEDICAL CENTER OF NORTHEASTERN PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALMEKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-243-3300
Mailing Address - Street 1:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0885
Mailing Address - Country:US
Mailing Address - Phone:570-243-3300
Mailing Address - Fax:570-338-3993
Practice Address - Street 1:511 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5731
Practice Address - Country:US
Practice Address - Phone:570-243-3300
Practice Address - Fax:570-338-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102546537001Medicaid
PA803207Medicare PIN