1134470602 NPI number — M J A HEALTHCARE OF THE LEHIGH VALLEY P C

Table of content: MRS. REBEKAH ERIN CALLAHAN LMFT (NPI 1942504071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134470602 NPI number — M J A HEALTHCARE OF THE LEHIGH VALLEY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M J A HEALTHCARE OF THE 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:
1134470602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
796 SEVEN BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301-7940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-872-9800
Provider Business Mailing Address Fax Number:
570-872-9888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 VAN BUREN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18045-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-438-4460
Provider Business Practice Location Address Fax Number:
610-438-4473
Provider Enumeration Date:
09/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ARTAMONOV
Authorized Official First Name:
MIKHAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/MD
Authorized Official Telephone Number:
610-438-4460

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  MD424898 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD424898 , 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)





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