Provider Demographics
NPI:1447346788
Name:FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMIN ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BARTALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-561-0128
Mailing Address - Street 1:425 12TH ST MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-0128
Mailing Address - Fax:609-567-8467
Practice Address - Street 1:425 12TH ST MADISON AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-561-0128
Practice Address - Fax:609-567-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1890107Medicaid
P380243OtherOXFORD
995004OtherUNITED HEALTH CARE
0074650001OtherAMERIHEALTH
E06079Medicare UPIN
P380243OtherOXFORD