Organization
NORTHEASTERN SURGICAL SPECIALTY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN F KOPEN MD (PRESIDENT)
(570) 283-2323
Entity
Organization
Contact information
Practice address
190 WELLES ST, FORTY FORT, PA 18704-4968
(570) 283-2323
(570) 283-1290
Mailing address
190 WELLES ST, FORTY FORT, PA 18704-4968
(570) 283-2323
(570) 283-1290
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010907280003
—
PA
01
—
072571
FIRST PRIORITY
PA
01
—
190358
HIGHMARK BLUE SHIELD
PA
01
—
25126
HEALTH AMERICA
PA
01
—
61472
AETNA US HEALTHCARE
PA
01
—
7227
GEISINGER HEALTH PLAN
PA
01
—
876894
COVENTRY
PA
01
—
88381
UNITED HEALTHCARE
PA
01
—
B34409
STERLING
PA
Enumeration date
07/05/2006
Last updated
11/01/2012
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