# JOSEPH P. CHOLLAK, JR., M.D.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407056732
- **Authorized official:** MRS. SHELLY MARANSKY (ADMIN ASSISTANT)
- **Authorized official phone:** (570) 287-7707

## Contact information

- **Practice address:** 950 WYOMING AVE, FORTY FORT, PA 18704-3966
- **Practice address phone:** (570) 287-7704
- **Mailing address:** 950 WYOMING AVE, FORTY FORT, PA 18704-3966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD-011393-E | PA | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | MD-011393-E | PA | — |
| 363A00000X | Physician Assistant | MA-003120-L | PA | — |

## Other

- **Enumeration date:** 07/24/2007
- **Last updated:** 11/27/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0008576980004 | — | PA |