Provider Demographics
NPI:1306949649
Name:POCONO PULMONARY ASSOC PC
Entity type:Organization
Organization Name:POCONO PULMONARY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHEMRAJ
Authorized Official - Middle Name:H
Authorized Official - Last Name:SEDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-476-5864
Mailing Address - Street 1:400 PLAZA COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18058
Mailing Address - Country:US
Mailing Address - Phone:570-476-5864
Mailing Address - Fax:570-476-6108
Practice Address - Street 1:400 PLAZA COURT
Practice Address - Street 2:SUITE A
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-422-6905
Practice Address - Fax:570-476-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
090557Medicare ID - Type Unspecified