MEDICARE: HARBOR FAMILY PRACTICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB07211700	NJ

General Provider Information

NPI Number	:	1073683660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	336 96TH ST
Second Line	:	SUITE 1
City	:	STONE HARBOR
State	:	NJ
Zip	:	08247-1439
Country	:	US
Telephone Number	:	609-967-0070
Fax Number	:	609-967-0077

Provider Business Practice Location Address
First Line	:	376 96TH ST
Second Line	:
City	:	STONE HARBOR
State	:	NJ
Zip	:	08247-1404
Country	:	US
Telephone Number	:	609-967-0070
Fax Number	:	609-967-0077

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TARA VOGDES
Credential	:	DO
Telephone Number	:	609-967-0070

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	10/15/2009

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