Healthcare Provider Details

I. General information

NPI: 1538231964
Provider Name (Legal Business Name): PLAZA FAMILY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 WILLOW GROVE ST SUITE 401
HACKETTSTOWN NJ
07840-1713
US

IV. Provider business mailing address

657 WILLOW GROVE ST SUITE 401
HACKETTSTOWN NJ
07840-1713
US

V. Phone/Fax

Practice location:
  • Phone: 908-850-7800
  • Fax: 908-850-7803
Mailing address:
  • Phone: 908-850-7800
  • Fax: 908-850-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06550000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA02678000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04754600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05455400
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08700100
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH NOCILLA JR.
Title or Position: PRACTICE ADMINISTRATOR
Credential: MHA
Phone: 908-850-7816