Provider Demographics
NPI:1073542254
Name:NOVA ANESTHESIA PROFESSIONALS
Entity type:Organization
Organization Name:NOVA ANESTHESIA PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-386-2366
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-0428
Mailing Address - Country:US
Mailing Address - Phone:570-386-2366
Mailing Address - Fax:570-386-3130
Practice Address - Street 1:1501 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-2112
Practice Address - Country:US
Practice Address - Phone:610-527-1400
Practice Address - Fax:610-527-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047126Medicare ID - Type Unspecified