Healthcare Provider Details

I. General information

NPI: 1851346738
Provider Name (Legal Business Name): STEPHEN JUDE KSIAZEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 SCHOENERSVILLE RD STE 301
BETHLEHEM PA
18017-7332
US

IV. Provider business mailing address

2100 MACK BLVD
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-4799
  • Fax: 484-893-8653
Mailing address:
  • Phone: 484-884-0617
  • Fax: 484-884-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD051899L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: