1962456319 NPI number — LEHIGH VALLEY FAMILY PRACTICE ASSOCIATES, LLP

Table of content: (NPI 1962456319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962456319 NPI number — LEHIGH VALLEY FAMILY PRACTICE ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEHIGH VALLEY FAMILY PRACTICE ASSOCIATES, LLP
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:
1962456319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 BRODHEAD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-8617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-694-9090
Provider Business Mailing Address Fax Number:
610-861-8295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 BRODHEAD RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-8617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-694-9090
Provider Business Practice Location Address Fax Number:
610-861-8295
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KANE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
D
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
610-694-9090

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP2300X , 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: 092995 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0166196 . This is a "KEYSTONE CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02350700 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000166196 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0166196 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001716003001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166196 . This is a "INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CN1759 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E1BX . This is a "VALLEY PREFERRED GEISINGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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