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General NPI Number Information
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NPI Number | 1679560403
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Entity Type | Organization
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Legal Business Name | PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1240 S CEDAR CREST BLVD SUITE #307
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City | ALLENTOWN
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State | PA
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Zip | 18103-6369
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Country | US
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Telephone | 610-402-1757
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Fax | 610-402-9089
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Provider Business Mailing Address
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Address Line | 1245 S CEDAR CREST BLVD SUITE #301
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City | ALLENTOWN
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State | PA
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Zip | 18103-6258
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Country | US
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Telephone | 610-402-1757
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Fax | 610-402-9089
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LORETTA KOWALICK
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Credential |
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Telephone | 610-402-1757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | PA
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