Provider Demographics
NPI:1376570127
Name:LEHIGH VALLEY FOOT & ANKLE SURGEONS, PC
Entity Type:Organization
Organization Name:LEHIGH VALLEY FOOT & ANKLE SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-391-0066
Mailing Address - Street 1:1575 POND RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2254
Mailing Address - Country:US
Mailing Address - Phone:610-391-0066
Mailing Address - Fax:610-391-0096
Practice Address - Street 1:1575 POND RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2254
Practice Address - Country:US
Practice Address - Phone:610-391-0066
Practice Address - Fax:610-391-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003737-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE7940OtherRAILROAD MEDICARE
PA02351100OtherCAPITAL BLUE CROSS GROUP
PA902886OtherBLUE SHIELD GROUP NUMBER
PA903791Medicare ID - Type UnspecifiedGROUP NUMBER
PA0866160001Medicare NSC