Provider Demographics
NPI:1093122392
Name:OCCUPATIONAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALEJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-794-8055
Mailing Address - Street 1:17-15 MAPLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1552
Mailing Address - Country:US
Mailing Address - Phone:201-794-8055
Mailing Address - Fax:201-794-8086
Practice Address - Street 1:17-15 MAPLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1552
Practice Address - Country:US
Practice Address - Phone:201-794-8055
Practice Address - Fax:201-794-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00336500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty