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General NPI Number Information
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NPI Number | 1316044225
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Entity Type | Organization
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Legal Business Name | LYONS-CHVALA NEPHROLOGY ASSOCIATES
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 231 N BROAD ST 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1511
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Country | US
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Telephone | 215-751-0606
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Fax | 215-751-0506
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Provider Business Mailing Address
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Address Line | 730 N BROAD ST SUITE 101
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City | WOODBURY
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State | NJ
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Zip | 08096-1796
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Country | US
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Telephone | 856-384-0238
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Fax | 856-384-4788
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KRISTEN E OWEN
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Credential |
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Telephone | 215-751-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD014096E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD025096E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD420924
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License Number State | PA
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