Basic Information
Provider Information
NPI: 1205491149
EntityType: 2
ReplacementNPI:  
OrganizationName: TREXLER PARK GYNECOLOGY
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Mailing Information
Address1: 1605 N CEDAR CREST BLVD STE 110B
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181042351
CountryCode: US
TelephoneNumber: 6109731410
FaxNumber: 6109731449
Practice Location
Address1: 3131 COLLEGE HEIGHTS BLVD STE 2200B
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181044812
CountryCode: US
TelephoneNumber: 6104403403
FaxNumber: 6104332395
Other Information
ProviderEnumerationDate: 05/07/2019
LastUpdateDate: 06/04/2019
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AuthorizedOfficialLastName: VIECHNICKI
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: BRUCE
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 6104403403
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VG0400X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

No ID Information.


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