Provider Demographics
NPI:1104929470
Name:NORTHEASTERN OCCUPATIONAL MEDICINE & REHABILITATION CENTER, P.C.
Entity type:Organization
Organization Name:NORTHEASTERN OCCUPATIONAL MEDICINE & REHABILITATION CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRICCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-341-7777
Mailing Address - Street 1:769 KEYSTONE INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512
Mailing Address - Country:US
Mailing Address - Phone:570-341-7777
Mailing Address - Fax:570-341-7789
Practice Address - Street 1:769 KEYSTONE INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512
Practice Address - Country:US
Practice Address - Phone:570-341-7777
Practice Address - Fax:570-341-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANE574368OtherBLUE SHIELD PROVIDER #
PANE574368OtherBLUE SHIELD PROVIDER #