Basic Information
| Provider Information | |||||||||
| NPI: | 1881653657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULTAN | ||||||||
| FirstName: | JUNAID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765100 | ||||||||
| FaxNumber: | 6106633113 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 E 21ST ST # B | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180671259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102621519 | ||||||||
| FaxNumber: | 6102627125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37314 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD432045 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3370382 | 05 | TN | MEDICAID | 1983995 | 01 | HIGHMARK BLUE SHIELD | OTHER | P008931 | 01 | GATEWAY HEALTH PLAN | OTHER | 50072127 | 01 | CBC | OTHER | 1020042170001 | 05 | PA | MEDICAID | 2861836000 | 01 | IBC | OTHER |