1679013098 NPI number — LEHIGH VALLEY WEIGHT LOSS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679013098 NPI number — LEHIGH VALLEY WEIGHT LOSS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEHIGH VALLEY WEIGHT LOSS 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:
1679013098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-7646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-821-8321
Provider Business Mailing Address Fax Number:
610-232-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 HAMILTON ST STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-821-8321
Provider Business Practice Location Address Fax Number:
610-232-7952
Provider Enumeration Date:
03/04/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAKOA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
610-419-9192

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VB0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083B0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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