Provider Demographics
NPI:1871764993
Name:CENTRAL PENN INTERVENTIONAL PAIN MEDICINE
Entity type:Organization
Organization Name:CENTRAL PENN INTERVENTIONAL PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIYI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABLA-YAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-490-1498
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17889-0099
Mailing Address - Country:US
Mailing Address - Phone:570-490-1498
Mailing Address - Fax:
Practice Address - Street 1:451 RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3722
Practice Address - Country:US
Practice Address - Phone:570-490-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057849L207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty