Provider Demographics
NPI:1164751004
Name:LEHIGH VALLEY PHYSICIAN GROUP
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHYSICIAN GROUP
Other - Org Name:LVPG PLASTIC AND RECONTRUCTIVE SURGERY - MUHLENBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP
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 1:2597 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7325
Practice Address - Country:US
Practice Address - Phone:484-884-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH VALLEY PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-23
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty