Provider Demographics
NPI:1144403718
Name:BRIDESBURG MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRIDESBURG MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-743-5959
Mailing Address - Street 1:2600 LEFEVRE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-1733
Mailing Address - Country:US
Mailing Address - Phone:215-743-5959
Mailing Address - Fax:215-743-4897
Practice Address - Street 1:2600 LEFEVRE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1733
Practice Address - Country:US
Practice Address - Phone:215-743-5959
Practice Address - Fax:215-743-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006177080005Medicaid
PAE55464Medicare UPIN