Provider Demographics
NPI:1366533192
Name:PHILADELPHIA OCCHEALTH DBA WORKNET OCCMED
Entity type:Organization
Organization Name:PHILADELPHIA OCCHEALTH DBA WORKNET OCCMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-5005
Mailing Address - Street 1:PO BOX 827842
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7918
Mailing Address - Country:US
Mailing Address - Phone:215-938-0800
Mailing Address - Fax:
Practice Address - Street 1:1800 BYBERRY RD
Practice Address - Street 2:SUITE 705
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3518
Practice Address - Country:US
Practice Address - Phone:215-938-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049587L261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58720Medicare UPIN