1952658536 NPI number — MR. RANDY ALAN HERZON LPC

Table of content: MR. RANDY ALAN HERZON LPC (NPI 1952658536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952658536 NPI number — MR. RANDY ALAN HERZON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERZON
Provider First Name:
RANDY
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

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:
1952658536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4277 SOMERSET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHNECKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18078-3543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-730-0443
Provider Business Mailing Address Fax Number:
610-481-0052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 BROADWAY
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:
18015-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-799-8600
Provider Business Practice Location Address Fax Number:
610-799-8154
Provider Enumeration Date:
08/13/2012

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: 101YP2500X , with the licence number:  PC006198 , 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)