Provider Demographics
NPI:1083640791
Name:WEST SIDE AVTS
Entity type:Organization
Organization Name:WEST SIDE AVTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:JANOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-8493
Mailing Address - Street 1:75 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1856
Mailing Address - Country:US
Mailing Address - Phone:570-288-8493
Mailing Address - Fax:
Practice Address - Street 1:75 EVANS ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-1856
Practice Address - Country:US
Practice Address - Phone:570-288-8493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019489570001Medicaid