Provider Demographics
NPI:1952394918
Name:EMAUS AVENUE FAMILY PRACTICE
Entity Type:Organization
Organization Name:EMAUS AVENUE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-797-2000
Mailing Address - Street 1:1101 W EMAUS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6676
Mailing Address - Country:US
Mailing Address - Phone:610-797-2000
Mailing Address - Fax:610-791-5814
Practice Address - Street 1:1101 W EMAUS AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6676
Practice Address - Country:US
Practice Address - Phone:610-797-2000
Practice Address - Fax:610-791-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAQW15076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010034098OtherRAILROAD MEDICARE
PA02278100OtherCAPITOL BLUE CROSS
PA4060281OtherEPHN
PA404523OtherHIGHMARK BLUE SHIELD
PA0097839001OtherKEYSTONE EAST
PA19455OtherAETNA US HEALTHCARE
PA204920OtherHEALTH AMERICA
PA010034098OtherRAILROAD MEDICARE
PA010034098OtherRAILROAD MEDICARE
PA0097839001OtherKEYSTONE EAST
PA204920OtherHEALTH AMERICA