Healthcare Provider Details

I. General information

NPI: 1962456319
Provider Name (Legal Business Name): LEHIGH VALLEY FAMILY PRACTICE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 BRODHEAD RD SUITE 101
BETHLEHEM PA
18017-8617
US

IV. Provider business mailing address

190 BRODHEAD RD SUITE 101
BETHLEHEM PA
18017-8617
US

V. Phone/Fax

Practice location:
  • Phone: 610-694-9090
  • Fax: 610-861-8295
Mailing address:
  • Phone: 610-694-9090
  • Fax: 610-861-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StatePA

VIII. Authorized Official

Name: ERIC D KANE
Title or Position: GENERAL PARTNER
Credential: DO
Phone: 610-694-9090