Provider Demographics
NPI:1659567725
Name:LYONS AND CHVALA NEPHROLOGY ASSOC.
Entity Type:Organization
Organization Name:LYONS AND CHVALA NEPHROLOGY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-384-0238
Mailing Address - Street 1:730 N BROAD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1796
Mailing Address - Country:US
Mailing Address - Phone:856-384-0238
Mailing Address - Fax:856-384-4788
Practice Address - Street 1:730 N BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1796
Practice Address - Country:US
Practice Address - Phone:856-384-0238
Practice Address - Fax:856-384-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07132600207RN0300X
NJMA34314207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8323500Medicaid
NJ8323500Medicaid
NJ044644Medicare PIN