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General NPI Number Information
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NPI Number | 1881987998
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Entity Type | Organization
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Legal Business Name | RIDGE AVENUE SPORTS MEDICINE, INC.
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 1150 GLENLIVET DR A-21
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City | ALLENTOWN
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State | PA
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Zip | 18106-3112
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Country | US
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Telephone | 484-664-7700
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Fax | 484-664-7701
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Provider Business Mailing Address
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Address Line | 514 N 24TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-4917
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Country | US
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Telephone | 484-664-7700
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Fax | 484-664-7701
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS MARCY LEA SOCRATES
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Credential |
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Telephone | 484-664-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD025425E
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License Number State | PA
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