1144254400 NPI number — ELYSE C LUBELL PHD

Table of content: ELYSE C LUBELL PHD (NPI 1144254400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144254400 NPI number — ELYSE C LUBELL PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBELL
Provider First Name:
ELYSE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1144254400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
197 WINDERMERE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-553-1252
Provider Business Mailing Address Fax Number:
610-398-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 HAMILTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-553-1252
Provider Business Practice Location Address Fax Number:
610-398-1949
Provider Enumeration Date:
07/10/2006

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: 103TC2200X , with the licence number:  PS015440 , 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)

  • Identifier: 2312064000 . This is a "BLUE SHIELD PERSONAL CHOI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1637239 . This is a "BLUE SHIELD HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G3543673 . This is a "OXFORD HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50058544 . This is a "BLUE SHIELD CAPITAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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