1699873901 NPI number — STEPHANIE M. LAKITS PA-C

Table of content: STEPHANIE M. LAKITS PA-C (NPI 1699873901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699873901 NPI number — STEPHANIE M. LAKITS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKITS
Provider First Name:
STEPHANIE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699873901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 E BROAD ST STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-5934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-626-0480
Provider Business Mailing Address Fax Number:
484-896-9002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3477 CORPORATE PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18034-8237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-626-0480
Provider Business Practice Location Address Fax Number:
484-896-9002
Provider Enumeration Date:
09/20/2006

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA052769 , 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)