Provider Demographics
NPI:1659397909
Name:CEDAR CREST EMERGICENTER LABORATORY
Entity Type:Organization
Organization Name:CEDAR CREST EMERGICENTER LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-435-3111
Mailing Address - Street 1:1101 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7902
Mailing Address - Country:US
Mailing Address - Phone:610-435-3111
Mailing Address - Fax:610-432-5953
Practice Address - Street 1:1101 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7902
Practice Address - Country:US
Practice Address - Phone:610-435-3111
Practice Address - Fax:610-432-5953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR CREST EMERGICENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA305404OtherHIGHMARK BLUE SHIELD
PA0041290002OtherKEYSTONE HEALTH PLAN EAST
PA305404OtherHIGHMARK BLUE SHIELD