| Commonwealth Physician Network Llc | |
|
4 E Main St Nanticoke PA 18634-1602 | |
| (570) 735-7474 | |
| (570) 735-2921 |
| Full Name | Commonwealth Physician Network Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4 E Main St, Nanticoke, Pennsylvania |
| Authorized Official Name and Position | Jennifer L Jackson (SENIOR DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8778929815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Physician Network Llc 4000 Meridian Blvd Franklin TN 37067-6325 Ph: (615) 465-7000 | Commonwealth Physician Network Llc 4 E Main St Nanticoke PA 18634-1602 Ph: (570) 735-7474 |
| NPI Number | 1003238635 |
|---|---|
| Provider Enumeration Date | 01/16/2014 |
| Last Update Date | 01/25/2022 |
| Medicare PECOS PAC ID | 2668696592 |
|---|---|
| Medicare Enrollment ID | O20140617000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003238635 | NPI | - | NPPES |
| 102897748 0001 | Medicaid | PA |
| Provider Name | Helen S Trygar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477592350 PECOS PAC ID: 9739088287 Enrollment ID: I20040105000465 |
| Provider Name | Javid Rohullah Amini |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689609638 PECOS PAC ID: 7517948367 Enrollment ID: I20040527000090 |
| Provider Name | Michael G Grasso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558374983 PECOS PAC ID: 5193709996 Enrollment ID: I20040617001303 |
| Provider Name | Sanjeev Garg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790728574 PECOS PAC ID: 0143206631 Enrollment ID: I20040625000535 |
| Provider Name | Krishnakant A Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669485918 PECOS PAC ID: 7719949643 Enrollment ID: I20041102000672 |
| Provider Name | Michalene M Torbik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578561023 PECOS PAC ID: 5092750018 Enrollment ID: I20050621000660 |
| Provider Name | Denise M Klynowsky-farrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730169079 PECOS PAC ID: 5193760593 Enrollment ID: I20050627000465 |
| Provider Name | Nnamdi A Davis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1609801430 PECOS PAC ID: 4880619675 Enrollment ID: I20051011000551 |
| Provider Name | Leonard A Kuchemba |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972539807 PECOS PAC ID: 2365462967 Enrollment ID: I20051128000755 |
| Provider Name | Bradley David Fenster |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1952394314 PECOS PAC ID: 3476574377 Enrollment ID: I20051207000530 |
| Provider Name | Mohammad S Siddiqui |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659481414 PECOS PAC ID: 1759322506 Enrollment ID: I20060215000216 |
| Provider Name | Nareshkumar R Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841226701 PECOS PAC ID: 5193734978 Enrollment ID: I20060406000612 |
| Provider Name | Ron J Konecke |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558397471 PECOS PAC ID: 2466461249 Enrollment ID: I20060406000622 |
| Provider Name | Eugene John Chiavacci |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992794630 PECOS PAC ID: 4082610225 Enrollment ID: I20061012000030 |
| Provider Name | Robert S Boova |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1942244215 PECOS PAC ID: 9638170871 Enrollment ID: I20070130000731 |
| Provider Name | William David Hottenstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588650154 PECOS PAC ID: 3678677846 Enrollment ID: I20070327000706 |
| Provider Name | Gary Langieri |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1336139724 PECOS PAC ID: 0143325829 Enrollment ID: I20070425000402 |
| Provider Name | Marie J Adajar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114932829 PECOS PAC ID: 9436249539 Enrollment ID: I20071213000020 |
| Provider Name | Jaromir Kohout |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245423367 PECOS PAC ID: 1456441070 Enrollment ID: I20071220000029 |
| Provider Name | Robert L Fiorelli |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568463784 PECOS PAC ID: 1153403803 Enrollment ID: I20080204000026 |
| Provider Name | Jodi A Calabro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518062595 PECOS PAC ID: 1557440328 Enrollment ID: I20080505000566 |
| Provider Name | Juan Jose Derojas |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1073581013 PECOS PAC ID: 1951473982 Enrollment ID: I20080708000161 |
| Provider Name | Imran Saeed |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1669501748 PECOS PAC ID: 1153495742 Enrollment ID: I20080730000603 |
| Provider Name | Daniel J Dudrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003825506 PECOS PAC ID: 6507865623 Enrollment ID: I20091113000276 |
| Provider Name | Louise Breakstone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831126010 PECOS PAC ID: 2769554070 Enrollment ID: I20091221000371 |
| Provider Name | Jacqueline Cain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891708533 PECOS PAC ID: 7113099425 Enrollment ID: I20091221000479 |
| Provider Name | Alan Boonin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942237961 PECOS PAC ID: 1850463167 Enrollment ID: I20091222000290 |
| Provider Name | Lanning A Anselmi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932112638 PECOS PAC ID: 6305918616 Enrollment ID: I20100316000280 |
| Provider Name | Kamlesh R Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235148388 PECOS PAC ID: 0345376836 Enrollment ID: I20100414000298 |
| Provider Name | Joan Cerra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710153101 PECOS PAC ID: 7012044290 Enrollment ID: I20100420000439 |
| Provider Name | David Peter Mouallem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730132200 PECOS PAC ID: 0143315036 Enrollment ID: I20101118000448 |
| Provider Name | Frank C Zhang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790992063 PECOS PAC ID: 9638367568 Enrollment ID: I20101220000676 |
| Provider Name | Ira Vohra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871769125 PECOS PAC ID: 0345438719 Enrollment ID: I20101229000639 |
| Provider Name | Michael Rittenberg |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1942261375 PECOS PAC ID: 2163574823 Enrollment ID: I20110118000038 |
| Provider Name | Gary Neale |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1104974328 PECOS PAC ID: 3375630106 Enrollment ID: I20110119000121 |
| Provider Name | John J Sirotnak |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1790757722 PECOS PAC ID: 0547442501 Enrollment ID: I20110311000409 |
| Provider Name | Barry J Pernikoff |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1609844646 PECOS PAC ID: 5799961074 Enrollment ID: I20110523000149 |
| Provider Name | Noelle Altavilla |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1275827008 PECOS PAC ID: 3678746278 Enrollment ID: I20111026000761 |
| Provider Name | Michael Raklewicz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1770595027 PECOS PAC ID: 0244407427 Enrollment ID: I20120112000100 |
| Provider Name | William P Charlton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1205848462 PECOS PAC ID: 0244497352 Enrollment ID: I20120201000403 |
| Provider Name | James M Mattucci |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1528070778 PECOS PAC ID: 7113184243 Enrollment ID: I20120201000570 |
| Provider Name | Walter Richard Delgaudio |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1730270968 PECOS PAC ID: 8921266941 Enrollment ID: I20120222000713 |
| Provider Name | Essam M Almeky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548442684 PECOS PAC ID: 8022198688 Enrollment ID: I20130218000175 |
| Provider Name | Angela Marie Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093029993 PECOS PAC ID: 8628262730 Enrollment ID: I20130503000322 |
| Provider Name | Matthew N Kozicki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124330410 PECOS PAC ID: 0749415123 Enrollment ID: I20131022000289 |
| Provider Name | Eric C Burdge |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851381339 PECOS PAC ID: 3375722523 Enrollment ID: I20140203000202 |
| Provider Name | Charles M Geller |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1417932880 PECOS PAC ID: 3577693290 Enrollment ID: I20141021000583 |
| Provider Name | Ahamed Razveen Shamsedeen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265710693 PECOS PAC ID: 6608008255 Enrollment ID: I20150714000112 |
| Provider Name | Christopher M Sanders |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1457543696 PECOS PAC ID: 1759694177 Enrollment ID: I20150714002218 |
| Provider Name | Karthik Penumetsa |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710151527 PECOS PAC ID: 2062728769 Enrollment ID: I20150826000159 |
| Provider Name | Michael Vito Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386809283 PECOS PAC ID: 4284808742 Enrollment ID: I20150831002930 |
| Provider Name | Kalyani Meduri |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1558513168 PECOS PAC ID: 6406032051 Enrollment ID: I20150921002667 |
| Provider Name | Julie Ann Ann Kane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114309150 PECOS PAC ID: 1153639364 Enrollment ID: I20151007001270 |
| Provider Name | Karen L Zikosky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972988327 PECOS PAC ID: 0143530485 Enrollment ID: I20151117001048 |
| Provider Name | Loren Mangino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851730550 PECOS PAC ID: 1254562309 Enrollment ID: I20161004000274 |
| Provider Name | Cherise Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558766535 PECOS PAC ID: 7113241365 Enrollment ID: I20161110000793 |
| Provider Name | Abhishek Freyer |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1982968459 PECOS PAC ID: 8022380294 Enrollment ID: I20170823000696 |
| Provider Name | Cindy Wu |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1275814527 PECOS PAC ID: 4385910017 Enrollment ID: I20171025002198 |
| Provider Name | Ryan Russell Seltzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417486572 PECOS PAC ID: 0244596310 Enrollment ID: I20171106000867 |
| Provider Name | Kevin K Musto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669884607 PECOS PAC ID: 4587965470 Enrollment ID: I20171106002117 |
| Provider Name | Christopher Thomas Mcandrew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588014518 PECOS PAC ID: 0345506309 Enrollment ID: I20171107001560 |
| Provider Name | Sarah Evans |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1427562636 PECOS PAC ID: 6103185582 Enrollment ID: I20180110000510 |
| Provider Name | Alicia E Novak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902314180 PECOS PAC ID: 9133482847 Enrollment ID: I20180411001227 |
| Provider Name | Philip V Savia |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487733564 PECOS PAC ID: 6800942673 Enrollment ID: I20180420001053 |
| Provider Name | Dante M Palumbo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1306801030 PECOS PAC ID: 6204859838 Enrollment ID: I20181016000577 |
| Provider Name | Devin Carey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366822504 PECOS PAC ID: 3476869207 Enrollment ID: I20181031002455 |
| Provider Name | Evan Z Nakib |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588830590 PECOS PAC ID: 2567534902 Enrollment ID: I20190125001730 |
| Provider Name | James Noto |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245641430 PECOS PAC ID: 6709113343 Enrollment ID: I20190806001029 |
| Provider Name | Nehal Mohammed Aleemuddin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518321082 PECOS PAC ID: 3173819554 Enrollment ID: I20190911000180 |
| Provider Name | Dean R Adams |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1700926078 PECOS PAC ID: 4688629504 Enrollment ID: I20190919002149 |
| Provider Name | Tara Mcgraw |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598156275 PECOS PAC ID: 4789988510 Enrollment ID: I20200917002877 |
| Provider Name | William Yi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861628729 PECOS PAC ID: 1254646573 Enrollment ID: I20200922001924 |
| Provider Name | Michelle Jeena Im |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134640717 PECOS PAC ID: 4486066982 Enrollment ID: I20201207001299 |
| Provider Name | Mazen Tolaymat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902291594 PECOS PAC ID: 1254630833 Enrollment ID: I20220707000957 |
| Provider Name | Adil Sattar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1235440652 PECOS PAC ID: 6709010879 Enrollment ID: I20220804003969 |
| Provider Name | Michael Karsy |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1972845345 PECOS PAC ID: 8628299534 Enrollment ID: I20221027001257 |
| Provider Name | Jill Ann Ferretti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093490161 PECOS PAC ID: 7416319728 Enrollment ID: I20230818001089 |
| Provider Name | Mohanad Sulaiman |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1962034132 PECOS PAC ID: 8123475050 Enrollment ID: I20231114001609 |
J.t. Huang, M.d. P.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 W Washington St, Suite A, Nanticoke, PA 18634 Phone: 570-258-0111 Fax: 570-258-0303 | |
Geisinger Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 E Main St, Nanticoke, PA 18634 Phone: 570-258-1304 | |
Northeast Counseling Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 24-26 E. Broad St, Nanticoke, PA 18634 Phone: 570-735-7590 | |
Cardiac Rehab Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 128 W Washington St, Nanticoke, PA 18634 Phone: 718-534-7888 Fax: 718-874-0088 | |
Janusz Wolanin Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 233 S Prospect St, Nanticoke, PA 18634 Phone: 570-735-0102 | |
Intermed Physicians Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4 E Main St, Nanticoke, PA 18634 Phone: 570-735-7474 Fax: 570-735-2921 |