Organization Name: | GLENDALE PRIMARY CARE LLC |
NPI Number: | 1588765291 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW G PINTO (OWNER/PHYSICIAN) |
Mailing Address: | 9 W Browning Rd # A Bellmawr |
State: | NJ US |
Postal Code: | 080312297 |
Phone Number: | 8569316950 |
Fax Number: | 8569316951 |
NPI Enumeration Date: | 09/26/2006 |
NPI Last Update Date: | 04/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | 25MB07937100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |