Organization
GERALD M BERESNY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER MARYCZ JR. REP (REP)
(570) 450-6206
Entity
Organization
Contact information
Practice address
611 UNIVERSITY DR, STATE COLLEGE, PA 16801-6552
(814) 234-7280
(814) 234-2490
Mailing address
PO BOX 517, HAZLETON, PA 18201-0517
(570) 450-6200
(570) 450-6207
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD0175586E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006015750001
—
PA
Enumeration date
10/23/2006
Last updated
08/22/2020
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