Basic Information
Provider Information
NPI: 1649507237
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BACHMAN
FirstName: REBEKAH
MiddleName: JOY
NamePrefix: MRS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: RENTLER
OtherFirstName: REBEKAH
OtherMiddleName: JOY
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 1754
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181051754
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840699
Practice Location
Address1: 1245 S CEDAR CREST BLVD
Address2: STE 201
City: ALLENTOWN
State: PA
PostalCode: 181036258
CountryCode: US
TelephoneNumber: 6104371931
FaxNumber: 6104338791
Other Information
ProviderEnumerationDate: 11/03/2009
LastUpdateDate: 10/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA054176PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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