Healthcare Provider Details

I. General information

NPI: 1134065618
Provider Name (Legal Business Name): GEORGE VIJAY JOSEPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 12TH ST
LEHIGHTON PA
18235-1138
US

IV. Provider business mailing address

211 N 12TH ST
LEHIGHTON PA
18235-1138
US

V. Phone/Fax

Practice location:
  • Phone: 610-577-0555
  • Fax:
Mailing address:
  • Phone: 610-577-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT236225
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: