Provider Demographics
NPI:1356372239
Name:CHILDRENS HEART CENTER OF NORTHEASTERN PENNSYLVANIA PC
Entity type:Organization
Organization Name:CHILDRENS HEART CENTER OF NORTHEASTERN PENNSYLVANIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANSROTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-437-6687
Mailing Address - Street 1:401 N 17TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5034
Mailing Address - Country:US
Mailing Address - Phone:610-437-6687
Mailing Address - Fax:610-437-5232
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-437-6687
Practice Address - Fax:610-437-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty