Provider Demographics
NPI:1801513197
Name:PRODHEALTH
Entity type:Organization
Organization Name:PRODHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-442-7247
Mailing Address - Street 1:301 BROADWAY STE 111
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1521
Mailing Address - Country:US
Mailing Address - Phone:610-442-7247
Mailing Address - Fax:
Practice Address - Street 1:301 BROADWAY STE 111
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1521
Practice Address - Country:US
Practice Address - Phone:610-442-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty