| Organization Name: | ANNANDALE FAMILY PRACTICE, LLC |
| NPI Number: | 1003080169 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA A SACCHIERI (DIRECTOR) |
| Mailing Address: | 56 Payne Rd Suite 21 Lebanon |
| State: | NJ US |
| Postal Code: | 088333262 |
| Phone Number: | 9082380100 |
| Fax Number: | 9082380951 |
| NPI Enumeration Date: | 04/18/2008 |
| NPI Last Update Date: | 04/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 25MA07764100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |