Organization
PENNSYLVANIA ASSOCIATES, LLC
Active
Other names
Mount Pocono Medical
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN TANIS (EXECUTIVE DIRECTOR OF CONTRACT MGMT)
(856) 533-8762
Entity
Organization
Contact information
Practice address
663 MOUNT POCONO BLVD, UNIT 3, MOUNT POCONO, PA 18344
(570) 839-7246
(570) 839-7248
Mailing address
1317 ROUTE 73 STE 200, MOUNT LAUREL, NJ 08054-2202
(856) 439-6111
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
457036
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
457036
PA DEPARTMENT OF HEALTH LICENSE NUMBER
PA
Enumeration date
01/13/2010
Last updated
12/06/2019
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