Provider Demographics
NPI:1467540286
Name:FIRST AVENUE OCCUPATIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:FIRST AVENUE OCCUPATIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-265-3200
Mailing Address - Street 1:860 1ST AVE
Mailing Address - Street 2:STE. 7A
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-3200
Mailing Address - Fax:610-265-6522
Practice Address - Street 1:860 1ST AVE
Practice Address - Street 2:7A
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-3200
Practice Address - Fax:610-265-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019365E261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine