Healthcare Provider Details

I. General information

NPI: 1588765291
Provider Name (Legal Business Name): GLENDALE PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W BROWNING RD # A
BELLMAWR NJ
08031-2297
US

IV. Provider business mailing address

9 W BROWNING RD # A
BELLMAWR NJ
08031-2297
US

V. Phone/Fax

Practice location:
  • Phone: 856-931-6950
  • Fax: 856-931-6951
Mailing address:
  • Phone: 856-931-6950
  • Fax: 856-931-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MB07937100
License Number StateNJ

VIII. Authorized Official

Name: DR. MATTHEW G PINTO
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 856-931-6950