Organization
YOUR NEIGHBORHOOD DOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMANUEL FERMIN HIPOLITO JR. M.D. (OWNER)
(814) 837-9841
Entity
Organization
Contact information
Practice address
38 THOMPSON PARK, KANE, PA 16735-0399
(814) 837-9841
(814) 837-6494
Mailing address
P O BOX 399, 38 THOMPSON PARK, KANE, PA 16735-0399
(814) 837-9841
(814) 837-6494
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD037007L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1630113
BLUE SHIELD
PA
Enumeration date
09/17/2007
Last updated
11/08/2007
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