Provider Demographics
NPI:1992442255
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:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:KASPRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:570-657-1634
Mailing Address - Street 1:10 W WHITE BEAR DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1728
Mailing Address - Country:US
Mailing Address - Phone:570-657-1634
Mailing Address - Fax:570-645-3397
Practice Address - Street 1:229 W BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1818
Practice Address - Country:US
Practice Address - Phone:570-657-1634
Practice Address - Fax:570-645-3397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:000000
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty