NPIMap

Organization Active NPI

Family Dermatology of the Lehigh Valley PC

  • Dermatology Physician
  • Schnecksville, PA
National Provider Identifier
1669444139
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD031979E Issued in PA
Legal business name
FAMILY DERMATOLOGY OF THE LEHIGH VALLEY PC
Practice address
4110 Independence Dr
Ste 300
Schnecksville, PA 18078
Phone
(610) 769-4200
Fax
(610) 769-4204
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

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

Authorized official

Name
Susan Jean Kucirka, MDNPI 1245209063
Title
Owner
Phone
(610) 769-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X MD031979E PA Primary

Addresses

Primary practice location

4110 Independence Dr
Ste 300
Schnecksville, PA 18078

Mailing address

4110 Independence Dr
Ste 300
Schnecksville, PA 18078
Phone (610) 769-4200

Other identifiers 2

IdentifierTypeStateIssuer
1580638OtherPABLUE SHIELD
50029439OtherPABLUE CROSS

National Provider Directory

National Provider Directory

Locations

4110 Independence Dr
Ste 300
Schnecksville, PA 18078
Phone (610) 769-4200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1669444139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 INDEPENDENCE DR",
            "address_2": "STE 300",
            "city": "SCHNECKSVILLE",
            "state": "PA",
            "postal_code": "18078",
            "telephone_number": "610-769-4200",
            "fax_number": "610-769-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 INDEPENDENCE DR",
            "address_2": "STE 300",
            "city": "SCHNECKSVILLE",
            "state": "PA",
            "postal_code": "18078",
            "telephone_number": "610-769-4200",
            "fax_number": "610-769-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DERMATOLOGY OF THE LEHIGH VALLEY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "KUCIRKA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-769-4200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD031979E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1580638",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "50029439",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schnecksville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.