Provider Demographics
NPI:1104195684
Name:LEHIGH VALLEY PHYSICIAN GROUP
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHYSICIAN GROUP
Other - Org Name:LVPG GENERAL AND BARIATRIC SURGERY-1240 CEDAR CREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERZINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-884-4500
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-402-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH VALLEY PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty