Healthcare Provider Details

I. General information

NPI: 1740723543
Provider Name (Legal Business Name): CHS PROFESSIONAL PRACTICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

IV. Provider business mailing address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY NYBERG
Title or Position: PRESIDENT & COO
Credential:
Phone: 610-861-8080