Organization
NORTHEAST KNEE AND JOINT INSTITUTE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN ROMAN MD (OWNER)
(570) 213-5221
Entity
Organization
Contact information
Practice address
3832 YALICK PLAZA ROUTE 415, UNIT 7, DALLAS, PA 18612-7753
(570) 213-5221
(570) 227-3316
Mailing address
PO BOX 3367, WILLIAMSPORT, PA 17701-0367
(570) 213-5221
(570) 227-3316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
11/08/2017
Last updated
07/15/2019
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