| |
415 Business Park Ln Allentown PA 18109-9120 | |
(267) 319-1530 | |
(267) 319-1531 |
Full Name | |
---|---|
Speciality | Clinic/center - Ambulatory Surgical |
Location | 415 Business Park Ln, Allentown, Pennsylvania |
Authorized Official Name and Position | Patrick Robert Stonich (DIRECTOR OF NURSING) |
Authorized Official Contact | 2673191530 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1233 Locust Street Suite 304 Philadelphia PA 19107 Ph: (267) 319-1530 | 415 Business Park Ln Allentown PA 18109-9120 Ph: (267) 319-1530 |
NPI Number | 1841475225 |
---|---|
Provider Enumeration Date | 01/04/2008 |
Last Update Date | 08/17/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841475225 | NPI | - | NPPES |
1021141200001 | Medicaid | PA | |
1083814933 | Other | PA | NPI ERIC |
1021144150001 | Medicaid | PA | |
1022406620001 | Medicaid | PA | |
1021082020001 | Medicaid | PA | |
1018007450002 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Primary |