Provider Demographics
NPI:1679560403
Name:PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.
Entity Type:Organization
Organization Name:PAIN SPECIALISTS OF GREATER LEHIGH VALLEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-402-1757
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-1757
Mailing Address - Fax:610-402-9089
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #307
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-402-1757
Practice Address - Fax:610-402-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208VP0000X, 261QP3300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1316068OtherHIGHMARK
PA0018828370001Medicaid
PA30000050OtherKEYSTONE MERCY
PA02009185000OtherIBC
PA03158300OtherCAPITAL BLUE CROSS
PA1316068OtherKHP CENTRAL
PA1522741OtherGATEWAY
PW20012177OtherAMERIHEALTH MERCY
PA2608852OtherAETNA
PW20012177OtherAMERIHEALTH MERCY
PA=========OtherCHOICE PLUS
PA2608852OtherAETNA
PA053038P7TMedicare PIN