1265846695 NPI number — LEHIGH VALLEY TOXICOLOGY LLC

Table of content: (NPI 1265846695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265846695 NPI number — LEHIGH VALLEY TOXICOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEHIGH VALLEY TOXICOLOGY LLC
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:
1265846695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 BRODHEAD RD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18020-8922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-566-2075
Provider Business Mailing Address Fax Number:
215-253-4110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 BRODHEAD RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-8922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-566-2075
Provider Business Practice Location Address Fax Number:
215-253-4110
Provider Enumeration Date:
06/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
267-566-2075

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00549889 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1695812 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00722 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003226322A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201003690 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2506790 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300028759 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0642894 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102980871 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0193241 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100094814 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2150156 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700019461 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098233 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19120K5D , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q053862 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114886700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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