Provider Demographics
NPI:1528262268
Name:JOHN BOSI DO,PC
Entity type:Organization
Organization Name:JOHN BOSI DO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOSI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-669-9818
Mailing Address - Street 1:50 E LOCUST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1310
Mailing Address - Country:US
Mailing Address - Phone:570-669-9818
Mailing Address - Fax:570-669-9841
Practice Address - Street 1:50 E LOCUST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NESQUEHONING
Practice Address - State:PA
Practice Address - Zip Code:18240-1310
Practice Address - Country:US
Practice Address - Phone:570-669-9818
Practice Address - Fax:570-669-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007458L202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014115840006Medicaid
PA0640447000OtherBLUE SHIELD PROVIDER NUMB
PA736350Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA0640447000OtherBLUE SHIELD PROVIDER NUMB