1366745176 NPI number — FAMILY CARE PHYSICIANS, LLC

Table of content: (NPI 1366745176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366745176 NPI number — FAMILY CARE PHYSICIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE PHYSICIANS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366745176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 WHITEHORSE AVE.
Provider Second Line Business Mailing Address:
SUITES 100-101
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-581-9099
Provider Business Mailing Address Fax Number:
609-581-9082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 WHITEHORSE AVE.
Provider Second Line Business Practice Location Address:
SUITES 100-101
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-581-9099
Provider Business Practice Location Address Fax Number:
609-581-9082
Provider Enumeration Date:
12/16/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CERTAGENA
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
609-581-9099

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA079438 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 25MA0549300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)