Basic Information
| Provider Information | |||||||||
| NPI: | 1558808287 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY KIDNEY SPECIALISTS, PC | ||||||||
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| OtherOrganizationName: | AZURA VALLEY ACCESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104324529 | ||||||||
| FaxNumber: | 6104322206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2014 CITY LINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102645199 | ||||||||
| FaxNumber: | 6102645198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2017 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | FELS | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6102645199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.