Healthcare Provider Details

I. General information

NPI: 1275571184
Provider Name (Legal Business Name): ELMER FAMILY PRACTICE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 ROUTE 40
ELMER NJ
08318-2532
US

IV. Provider business mailing address

PO BOX 577
ELMER NJ
08318-0577
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-0770
  • Fax: 856-358-0108
Mailing address:
  • Phone: 856-358-0770
  • Fax: 856-358-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY KOSLICK
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 856-358-0770