Healthcare Provider Details

I. General information

NPI: 1508400920
Provider Name (Legal Business Name): NAZARETH ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 NORTHAMPTON ST STE 220
EASTON PA
18045-2764
US

IV. Provider business mailing address

2401 NORTHAMPTON ST STE 220
EASTON PA
18045-2764
US

V. Phone/Fax

Practice location:
  • Phone: 610-821-2828
  • Fax: 610-821-7915
Mailing address:
  • Phone: 610-821-2828
  • Fax: 610-821-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MELINDA LOPEZ
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 610-756-9900