Provider Demographics
NPI:1366745176
Name:FAMILY CARE PHYSICIANS, LLC
Entity type:Organization
Organization Name:FAMILY CARE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CERTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-9099
Mailing Address - Street 1:445 WHITEHORSE AVE.
Mailing Address - Street 2:SUITES 100-101
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610
Mailing Address - Country:US
Mailing Address - Phone:609-581-9099
Mailing Address - Fax:609-581-9082
Practice Address - Street 1:445 WHITEHORSE AVE.
Practice Address - Street 2:SUITES 100-101
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610
Practice Address - Country:US
Practice Address - Phone:609-581-9099
Practice Address - Fax:609-581-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0549300208000000X
NJ25MA079438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty