Organization
GERIATRIC RESEARCH & CONSULTING GROUP LLC
Active
Other names
Northeast Pennsylvania Memory and Alzheimers Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO CORNACCHIONE D.O (OWNER)
(570) 829-1095
Entity
Organization
Contact information
Practice address
1200 ALEEDA BLVD, BEAR CREEK TOWNSHIP, PA 18702-9611
(570) 829-1095
Mailing address
1200 ALEEDA BLVD, BEAR CREEK TOWNSHIP, PA 18702-9611
(570) 829-1095
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
OS005253L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS005253
MEDICAL LICENSE
PA
Enumeration date
05/30/2008
Last updated
07/10/2008
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