Provider Demographics
NPI:1194927210
Name:VERTIGON LLC
Entity type:Organization
Organization Name:VERTIGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:P
Authorized Official - Last Name:POTELUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-237-0349
Mailing Address - Street 1:1000 MEADE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3197
Mailing Address - Country:US
Mailing Address - Phone:570-342-0800
Mailing Address - Fax:570-969-1200
Practice Address - Street 1:1000 MEADE ST STE 202
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3197
Practice Address - Country:US
Practice Address - Phone:570-342-0800
Practice Address - Fax:570-969-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic