1225139066 NPI number — GASTROENTEROLOGY ASSOCIATES OF PENN MEDICAL GROUP, P.C.

Table of content: ELJESS CLERVIL PMHNP (NPI 1629897459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225139066 NPI number — GASTROENTEROLOGY ASSOCIATES OF PENN MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOCIATES OF PENN MEDICAL GROUP, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1225139066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 W HAMILTON ST
Provider Second Line Business Mailing Address:
SUITE 100B
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-6459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-973-1400
Provider Business Mailing Address Fax Number:
610-973-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-379-0443
Provider Business Practice Location Address Fax Number:
610-379-0587
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENSINGER
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
610-379-0443

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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