Provider Demographics
NPI:1700142064
Name:BEAR, EMILY JOY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JOY
Last Name:BEAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HADDONFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2604
Mailing Address - Country:US
Mailing Address - Phone:856-663-7690
Mailing Address - Fax:856-663-9269
Practice Address - Street 1:800 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2604
Practice Address - Country:US
Practice Address - Phone:856-663-7690
Practice Address - Fax:856-663-9269
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MO00273000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant