1679560403 NPI number — PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.

Table of content: (NPI 1679560403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679560403 NPI number — PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.
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:
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:
1679560403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 S CEDAR CREST BLVD
Provider Second Line Business Mailing Address:
SUITE #301
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103-6258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-402-1757
Provider Business Mailing Address Fax Number:
610-402-9089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE #307
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-1757
Provider Business Practice Location Address Fax Number:
610-402-9089
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KOWALICK
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
610-402-1757

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1316068 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018828370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30000050 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02009185000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03158300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1316068 . This is a "KHP CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1522741 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20012177 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 2608852 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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