Healthcare Provider Details

I. General information

NPI: 1821024308
Provider Name (Legal Business Name): ALL CARE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 DIAMOND BRIDGE AVE
HAWTHORNE NJ
07506-0000
US

IV. Provider business mailing address

5 JENNY LANE
WAYNE NJ
07470-1940
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-0600
  • Fax: 973-427-0604
Mailing address:
  • Phone: 973-427-0600
  • Fax: 973-427-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB064309
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MD06430900
License Number StateNJ

VIII. Authorized Official

Name: DOUGLAS BIENSTOCK
Title or Position: DO/DIRECTOR
Credential: DO
Phone: 973-427-0604