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Organization
STRP FACULTY SERVICE
Active
Organization
STRP FACULTY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIDORO PRIMERO (CHIEF FINANCIAL OFFICER)
(570) 941-0630
Entity
Organization
Contact information
Practice address
640 MADISON AVE, SCRANTON, PA 18510-1607
(570) 961-5670
(570) 961-5991
Mailing address
746 JEFFERSON AVE, SCRANTON, PA 18510-1624
(570) 343-2383
(570) 963-6133
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0663952
—
PA
Enumeration date
09/23/2005
Last updated
07/21/2022
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