Healthcare Provider Details

I. General information

NPI: 1205452760
Provider Name (Legal Business Name): XALER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4379 EASTON AVE # 110
BETHLEHEM PA
18020-1483
US

IV. Provider business mailing address

4379 EASTON AVE # 110
BETHLEHEM PA
18020-1483
US

V. Phone/Fax

Practice location:
  • Phone: 260-564-1205
  • Fax:
Mailing address:
  • Phone: 260-564-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SADIA ALTAF
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 914-374-4057