1306907886 NPI number — CEDAR BROOK FAMILY PRACTICE PC

Table of content: (NPI 1306907886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306907886 NPI number — CEDAR BROOK FAMILY PRACTICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR BROOK FAMILY PRACTICE 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:
1306907886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR BROOK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08018-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-567-2101
Provider Business Mailing Address Fax Number:
609-704-9351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
187 S ROUTE 73
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAMMONTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08037-9423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-567-2101
Provider Business Practice Location Address Fax Number:
609-704-9351
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUCCI
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
609-567-2101

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MB055669 , 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)





Copyright © 2007-2025 www.npivalidator.com