Provider Demographics
NPI:1174929897
Name:PEDIATRIC NEUROLOGY OF LEHIGH VALLEY, PC
Entity type:Organization
Organization Name:PEDIATRIC NEUROLOGY OF LEHIGH VALLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-201-1126
Mailing Address - Street 1:1517 POND RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2253
Mailing Address - Country:US
Mailing Address - Phone:484-201-1126
Mailing Address - Fax:
Practice Address - Street 1:1517 POND RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2253
Practice Address - Country:US
Practice Address - Phone:484-201-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4317692084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty