Healthcare Provider Details

I. General information

NPI: 1326622069
Provider Name (Legal Business Name): AVENUES RECOVERY MEDICAL CENTER AT VALLEY FORGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 W GERMANTOWN PIKE
NORRISTOWN PA
19403-3905
US

IV. Provider business mailing address

850 TOWBIN AVE
LAKEWOOD NJ
08701-5928
US

V. Phone/Fax

Practice location:
  • Phone: 610-539-8500
  • Fax:
Mailing address:
  • Phone: 732-886-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIEZER FRIEDMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 732-886-6202