1295957769 NPI number — WASHINGTON FAMILY MEDICINE, PC

Table of content: (NPI 1295957769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295957769 NPI number — WASHINGTON FAMILY MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON FAMILY MEDICINE, PC
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:
1295957769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 SMITHFIELD COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASKING RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07920-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-348-9173
Provider Business Mailing Address Fax Number:
908-271-6556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 US HIGHWAY 206
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FLANDERS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07836-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-584-0045
Provider Business Practice Location Address Fax Number:
973-584-0094
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
SOFIA
Authorized Official Middle Name:
RAMONA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-348-9173

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  25MA07631200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174678114 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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