| Organization Name: | PENNSUAKEN FAMILY PRACTICE, PC |
| NPI Number: | 1518187392 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HERMAN P COHEN (OWNER) |
| Mailing Address: | 5647 Westfield Ave Pennsauken |
| State: | NJ US |
| Postal Code: | 081101836 |
| Phone Number: | 8566631470 |
| Fax Number: | 8566633409 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 05/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 61259 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |