# NORTHEAST KNEE AND JOINT INSTITUTE, LLC.

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

## Provider details

- **NPI number:** 1689187072
- **Authorized official:** EDWIN ROMAN MD (OWNER)
- **Authorized official phone:** (570) 213-5221

## Contact information

- **Practice address:** 3832 YALICK PLAZA ROUTE 415, UNIT 7, DALLAS, PA 18612-7753
- **Practice address phone:** (570) 213-5221
- **Practice address fax:** (570) 227-3316
- **Mailing address:** PO BOX 3367, WILLIAMSPORT, PA 17701-0367
- **Mailing address phone:** (570) 213-5221
- **Mailing address fax:** (570) 227-3316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/08/2017
- **Last updated:** 07/15/2019