Provider Demographics
NPI:1316044225
Name:LYONS-CHVALA NEPHROLOGY ASSOCIATES
Entity type:Organization
Organization Name:LYONS-CHVALA NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-751-0606
Mailing Address - Street 1:730 N BROAD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1796
Mailing Address - Country:US
Mailing Address - Phone:856-384-0238
Mailing Address - Fax:856-384-4788
Practice Address - Street 1:231 N BROAD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-751-0606
Practice Address - Fax:215-751-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014096E174400000X
PAMD025096E174400000X
PAMD420924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000807140000Medicaid
NJ8323500Medicaid
PA000694716000Medicaid
PA1016204420001Medicaid
PA000694716000Medicaid
PAI33709Medicare UPIN
PAB36991Medicare UPIN
NJ8323500Medicaid