Provider Demographics
NPI:1407057839
Name:OCCUPATIONAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOEHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-9125
Mailing Address - Street 1:200 MULLIN ST
Mailing Address - Street 2:#201
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3619
Mailing Address - Country:US
Mailing Address - Phone:315-782-9125
Mailing Address - Fax:315-786-1564
Practice Address - Street 1:200 MULLIN ST
Practice Address - Street 2:#201
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3619
Practice Address - Country:US
Practice Address - Phone:315-782-9125
Practice Address - Fax:315-786-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104750207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52025AMedicare ID - Type UnspecifiedMEDICARE