Provider Demographics
NPI:1588874838
Name:HEART CARE OF THE POCONOS, PC
Entity type:Organization
Organization Name:HEART CARE OF THE POCONOS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:INDZONKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-421-3800
Mailing Address - Street 1:100 PLAZA CT STE C
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:570-421-3800
Mailing Address - Fax:570-421-8014
Practice Address - Street 1:100 PLAZA CT STE C
Practice Address - Street 2:SUITE B
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-421-3800
Practice Address - Fax:570-421-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001433595OtherHIGHMARK BLUE SHIELD
PA091650Medicare ID - Type Unspecified