Healthcare Provider Details

I. General information

NPI: 1972153997
Provider Name (Legal Business Name): EASTERN PENNSYLVANIA ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CEDAR CREST BLVD STE 100
ALLENTOWN PA
18104-2309
US

IV. Provider business mailing address

1501 N CEDAR CREST BLVD STE 100
ALLENTOWN PA
18104-2309
US

V. Phone/Fax

Practice location:
  • Phone: 610-289-2172
  • Fax:
Mailing address:
  • Phone: 610-289-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA LOMBARDO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 610-821-2828