Healthcare Provider Details

I. General information

NPI: 1366745176
Provider Name (Legal Business Name): FAMILY CARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WHITEHORSE AVE. SUITES 100-101
HAMILTON NJ
08610
US

IV. Provider business mailing address

445 WHITEHORSE AVE. SUITES 100-101
HAMILTON NJ
08610
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-9099
  • Fax: 609-581-9082
Mailing address:
  • Phone: 609-581-9099
  • Fax: 609-581-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA0549300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA079438
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. CARMEN M. CERTAGENA
Title or Position: OFFICE MANAGER
Credential:
Phone: 609-581-9099