Basic Information
| Provider Information | |||||||||
| NPI: | 1700142064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAR | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 HADDONFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566637690 | ||||||||
| FaxNumber: | 8566639269 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HADDONFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566637690 | ||||||||
| FaxNumber: | 8566639269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 04/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MO00273000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.