Provider Demographics
NPI:1063903151
Name:DR STEPHEN JADITZ LLC
Entity type:Organization
Organization Name:DR STEPHEN JADITZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JADITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-586-8186
Mailing Address - Street 1:105 LAYTON RD P O BOX 478
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9376
Mailing Address - Country:US
Mailing Address - Phone:570-586-8186
Mailing Address - Fax:570-587-0758
Practice Address - Street 1:105 LAYTON RD # 478
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9376
Practice Address - Country:US
Practice Address - Phone:570-586-8186
Practice Address - Fax:570-587-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006343L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty