Provider Demographics
NPI:1104878412
Name:NORTHEASTERN REHABILITATION ASSOCIATES, PC
Entity type:Organization
Organization Name:NORTHEASTERN REHABILITATION ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHAN-GATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-344-3788
Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:570-969-9280
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-969-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001252657-0006Medicaid
PA534357OtherAETNA
PA68718OtherUNISON
PA0474468000OtherKEYSTONE EAST
PA1067OtherGEISINGER
PA20022351OtherAMERIHEALTH
PACF8495OtherRAILROAD MEDICARE
PA643767OtherBLUE CARE/HIGHMARK BLUE SHIELD
PA68719OtherTHREE RIVERS
PA68719OtherTHREE RIVERS