1043258015 NPI number — LEHIGH VALLEY NEPHROLOGY ASSOC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043258015 NPI number — LEHIGH VALLEY NEPHROLOGY ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEHIGH VALLEY NEPHROLOGY ASSOC
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:
1043258015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 OSTRUM ST
Provider Second Line Business Mailing Address:
SUITE 602
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-865-5888
Provider Business Mailing Address Fax Number:
610-865-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 OSTRUM ST
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-865-5888
Provider Business Practice Location Address Fax Number:
610-865-1697
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PURSELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
610-865-5888

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20044600 . This is a "AMERIHEALTH MERCY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011249240021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519711 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131084 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02348300 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193798 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3564401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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