1538438643 NPI number — GAYE C. BEATTY, LLC

Table of content: (NPI 1538438643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538438643 NPI number — GAYE C. BEATTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAYE C. BEATTY, 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:
1538438643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 LENAIRE RD
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:
18020-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-419-4190
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-434-0962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTY
Authorized Official First Name:
GAYE
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
610-434-0962

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  CW001507-L , 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: 645751 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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