Organization Name: | BORDENTOWN FAMILY PRACTICE PA |
NPI Number: | 1477811107 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOISHE STARKMAN (PRESIDENT) |
Mailing Address: | 163 Route 130 Bldg. 1 Suite B Bordentown |
State: | NJ US |
Postal Code: | 085052248 |
Phone Number: | 6092982992 |
Fax Number: | 6092918359 |
NPI Enumeration Date: | 05/01/2012 |
NPI Last Update Date: | 05/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | MA50962 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |