Provider Demographics
NPI:1205491149
Name:TREXLER PARK GYNECOLOGY
Entity type:Organization
Organization Name:TREXLER PARK GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:VIECHNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-440-3403
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD STE 2200B
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-440-3403
Practice Address - Fax:610-433-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty