Individual
NCHE ZAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 E BROWN ST, EAST STROUDSBURG, PA 18301-3006
(570) 420-5331
(570) 422-8233
Mailing address
571 SAINT JOSEPHS BLVD, FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
(607) 271-2099
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
215259-1
NY
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD049700L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014325660004
—
PA
05
—
0014325660008
—
PA
05
—
0014325660009
—
PA
05
—
01948801
—
NY
01
—
0650047000
KEYSTONE IBC
PA
01
—
3416861
AETNA
PA
01
—
741362
HIGHMARK BLUE SHIELD
PA
Enumeration date
03/03/2006
Last updated
06/06/2018
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