=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679795165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEHIGH VALLEY PHYSICIAN GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17TH & CHEW ST SUITE 403
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18102-3698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-969-3600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 78331
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19178-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-884-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP
-----------------------------------------------------
Name | JOHN BERZINSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-884-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------