Provider Demographics
NPI: | 1598909707 |
---|---|
Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Entity type: | Organization |
Organization Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSOCIATE EXEC DIRECTOR OF FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | KNOX |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 610-798-4500 |
Mailing Address - Street 1: | PO BOX 1754 |
Mailing Address - Street 2: | |
Mailing Address - City: | ALLENTOWN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18105-1754 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2604 SCHOENERSVILLE RD |
Practice Address - Street 2: | |
Practice Address - City: | BETHLEHEM |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18017-3518 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-691-8028 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LEHIGH VALLEY PHYSICIAN GROUP |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2009-05-01 |
Last Update Date: | 2009-05-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |