1609898584 NPI number — ALC OF LEHIGH VALLEY INC

Table of content: (NPI 1609898584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609898584 NPI number — ALC OF LEHIGH VALLEY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALC OF LEHIGH VALLEY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AZANI MEDICAL SPA
Provider Other Organization Name Type Code:
3
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:
1609898584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3067 JORDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18069-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-625-3000
Provider Business Mailing Address Fax Number:
610-625-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 EMRICK BLVD
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-8037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-625-3000
Provider Business Practice Location Address Fax Number:
610-625-3003
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
CECILIA
Authorized Official Title or Position:
CEO/MEDICAL DIRECTOR
Authorized Official Telephone Number:
610-530-0151

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MD061743L , 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)