NPIMap

Individual provider Active NPI

Nitya Bandla Mambalam, M.D,

  • Neurology Physician
  • Bethlehem, PA
National Provider Identifier
1376983767
Registry record updated Oct 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD458239 Issued in PA
Practice address
1417 8TH Ave
Bethlehem, PA 18018-2256
Phone
(484) 526-5210
Fax
(484) 526-5237
NPI assigned
Jun 28, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD458239 PA Primary

Addresses

Primary practice location

1417 8TH Ave
Bethlehem, PA 18018-2256

Mailing address

1417 8TH Ave
Bethlehem, PA 18018-2256
Phone (484) 526-5210

Other identifiers 1

IdentifierTypeStateIssuer
2013021634OtherMOMISSOURI TEMPORARY LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171019000192 PA Practitioner - Neurology 2264676931 Reassigns benefits to 2 organizations
I20180419002354 NJ Practitioner - Neurology 2264676931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gslpg, IncGroup PAC ID 7810226875, 269 clinicians
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

100 Paramount Blvd
Orwigsburg, PA 17961-2202
Phone (272) 639-4990

1417 8TH Ave
St Luke's Neurology Associates
Bethlehem, PA 18018-0000
Phone (484) 526-5210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Physician Group, Inc. CurrentSince Sep 1, 2017 Accepting new patients
St. Luke's Warren Physician Group, PC CurrentSince Apr 2, 2018 Accepting new patients
Gslpg, Inc CurrentSince Nov 4, 2019 Accepting new patients
St Luke's Physician Group Inc CurrentSince Sep 1, 2017 Accepting new patients
St. Luke's Warren Physician Group, PC CurrentSince Apr 2, 2018 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St. Luke's Warren Physician Group, PC Current Accepting new patients
St. Luke's Physician Group, Inc. Past Accepting new patients

Locations

185 Roseberry St
Bldg 2ND
Phillipsburg, NJ 08865
Phone (908) 847-2619

279 State Route 31 S
Washington, NJ 07882
Phone (908) 689-2201

700 Horizon Dr
Ste 201
Chalfont, PA 18914
Phone (215) 453-2510

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

100 Paramount Blvd
Orwigsburg, PA 17961
Phone (272) 639-1000

Interoperability endpoints

  • Direct secure messaging: nitya.mambalam@slpg.direct-sluhn.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1376983767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 8TH AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180182256",
            "telephone_number": "484-526-5210",
            "fax_number": "484-526-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 8TH AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180182256",
            "telephone_number": "484-526-5210",
            "fax_number": "484-526-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMBALAM",
        "first_name": "NITYA",
        "middle_name": "BANDLA",
        "credential": "M.D,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-28",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD458239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI TEMPORARY LICENSE",
            "identifier": "2013021634",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.