Provider Demographics
NPI:1124767355
Name:NORTHEAST CRITICAL CARE LTD
Entity type:Organization
Organization Name:NORTHEAST CRITICAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:KASPRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP-BC
Authorized Official - Phone:570-657-1634
Mailing Address - Street 1:229 W BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252
Mailing Address - Country:US
Mailing Address - Phone:570-657-1634
Mailing Address - Fax:
Practice Address - Street 1:229 W BROAD STREET
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252
Practice Address - Country:US
Practice Address - Phone:570-657-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST CRITICAL CARE LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty