1306814736 NPI number — STEPHANIE ECKERT D.O.

Table of content: JOHN S HALSEY MD (NPI 1417944463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306814736 NPI number — STEPHANIE ECKERT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKERT
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306814736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 POND RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-366-7444
Provider Business Mailing Address Fax Number:
610-366-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6553 HOFFMAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18036-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-366-7444
Provider Business Practice Location Address Fax Number:
610-366-0884
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS009276L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500134 . This is a "GROUP AETNA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7077147 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01048101 . This is a "CAP BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02294500 . This is a "GROUP CAP BLUE CROSS NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0268906000 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 122834 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 993220 . This is a "KHPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 124389 . This is a "GROUP PA BLUE SHIELD #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1511442 . This is a "GROUP GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018039500001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0794403000 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0917174 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518827 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 026890600 . This is a "GROUP KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20008892 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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