Healthcare Provider Details

I. General information

NPI: 1134470602
Provider Name (Legal Business Name): M J A HEALTHCARE OF THE LEHIGH VALLEY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 VAN BUREN RD SUITE 101
EASTON PA
18045-2030
US

IV. Provider business mailing address

796 SEVEN BRIDGE RD
EAST STROUDSBURG PA
18301-7940
US

V. Phone/Fax

Practice location:
  • Phone: 610-438-4460
  • Fax: 610-438-4473
Mailing address:
  • Phone: 570-872-9800
  • Fax: 570-872-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD424898
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMD424898
License Number StatePA

VIII. Authorized Official

Name: DR. MIKHAIL ARTAMONOV
Title or Position: PRESIDENT/MD
Credential: M.D.
Phone: 610-438-4460