Basic Information
| Provider Information | |||||||||
| NPI: | 1104874064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN PENNSYLVANIA GASTROENTEROLOGY AND LIVER SPECIALISTS,P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108212828 | ||||||||
| FaxNumber: | 6108217915 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108212828 | ||||||||
| FaxNumber: | 6108217915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | AUTERI | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6108212828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0009936080007 | 05 | PA | MEDICAID |