Healthcare Provider Details

I. General information

NPI: 1154095628
Provider Name (Legal Business Name): SETH KRIVCHENIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

2415 W ALLEN ST
ALLENTOWN PA
18104-4932
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4000
  • Fax: 484-526-4586
Mailing address:
  • Phone: 609-828-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT225803
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD486412
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: