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564 Main St Second Floor Stroudsburg PA 18360-2004 | |
| (570) 420-8070 | |
| (570) 424-6487 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 564 Main St, Stroudsburg, Pennsylvania |
| Authorized Official Name and Position | Tim Sohosky (COO) |
| Authorized Official Contact | 5706825215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
564 Main St Second Floor Stroudsburg PA 18360-2004 Ph: (570) 420-8070 | 564 Main St Second Floor Stroudsburg PA 18360-2004 Ph: (570) 420-8070 |
| NPI Number | 1538145453 |
|---|---|
| Provider Enumeration Date | 12/22/2005 |
| Last Update Date | 07/12/2024 |
| Certification Date | 07/12/2024 |
| Medicare PECOS PAC ID | 7911802228 |
|---|---|
| Medicare Enrollment ID | O20031201000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538145453 | NPI | - | NPPES |
| 1000017170176 | Medicaid | PA |
| Provider Name | Edward D Sesack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063446052 PECOS PAC ID: 9638074909 Enrollment ID: I20031201000611 |
| Provider Name | John L Rehnert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417933045 PECOS PAC ID: 0446155683 Enrollment ID: I20031202000129 |
| Provider Name | Peter A Migaly |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760403422 PECOS PAC ID: 6709923592 Enrollment ID: I20091028000033 |
| Provider Name | Elmer Cupino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376518977 PECOS PAC ID: 2062698707 Enrollment ID: I20110516000058 |
| Provider Name | Cynthia Ann Reddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568806677 PECOS PAC ID: 8022259837 Enrollment ID: I20130720000068 |
| Provider Name | Angeline Saxon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316357783 PECOS PAC ID: 5698087674 Enrollment ID: I20150706000291 |
| Provider Name | Barbara A.w. Poncelet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942236799 PECOS PAC ID: 2668756198 Enrollment ID: I20170301001928 |
| Provider Name | Deborah Meyers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013420587 PECOS PAC ID: 8224396346 Enrollment ID: I20171219002465 |
| Provider Name | Katie Ulrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104469188 PECOS PAC ID: 1456788256 Enrollment ID: I20200217000455 |
| Provider Name | Niru Nahar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316182074 PECOS PAC ID: 5799841102 Enrollment ID: I20200804001576 |
| Provider Name | Wilson G Fuchi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528773793 PECOS PAC ID: 6002258258 Enrollment ID: I20240520003884 |
| Provider Name | Constance M Walck |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184802548 PECOS PAC ID: 3173056462 Enrollment ID: I20241024003126 |
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