Healthcare Provider Details

I. General information

NPI: 1679013098
Provider Name (Legal Business Name): LEHIGH VALLEY WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2017
Last Update Date: 11/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAMILTON ST STE 111
ALLENTOWN PA
18104-6329
US

IV. Provider business mailing address

26 CREEK CT
EASTON PA
18040-7646
US

V. Phone/Fax

Practice location:
  • Phone: 610-821-8321
  • Fax: 610-232-7952
Mailing address:
  • Phone: 610-821-8321
  • Fax: 610-232-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES NAKOA JR.
Title or Position: BILLING MANAGER
Credential:
Phone: 610-419-9192