Healthcare Provider Details

I. General information

NPI: 1790073963
Provider Name (Legal Business Name): LEHIGH VALLEY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 S CEDAR CREST BLVD SUITE 2200
ALLENTOWN PA
18103-6268
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-2500
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePA

VIII. Authorized Official

Name: JENNIFER STEPHENS
Title or Position: SR VP & CHIEF VALUE OFFICER
Credential:
Phone: 484-862-3152