Healthcare Provider Details

I. General information

NPI: 1104901883
Provider Name (Legal Business Name): ROBERT JAY ECHENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W UNION BLVD SUITE 5
BETHLEHEM PA
18018-3708
US

IV. Provider business mailing address

623 W UNION BLVD SUITE 5
BETHLEHEM PA
18018-3708
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-0104
  • Fax: 610-868-0204
Mailing address:
  • Phone: 610-868-0104
  • Fax: 610-868-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD013092E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: