Healthcare Provider Details

I. General information

NPI: 1649259110
Provider Name (Legal Business Name): PAUL HENRY SCHENCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 HAMILTON BLVD
ALLENTOWN PA
18106-9153
US

IV. Provider business mailing address

201 E LAUREL BLVD
POTTSVILLE PA
17901-2534
US

V. Phone/Fax

Practice location:
  • Phone: 610-398-2800
  • Fax: 610-366-1343
Mailing address:
  • Phone: 610-398-2800
  • Fax: 610-366-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD017334E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: