Healthcare Provider Details

I. General information

NPI: 1952236481
Provider Name (Legal Business Name): CONNECTED FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SHEFFIELD ST
MOUNTAINSIDE NJ
07092-2314
US

IV. Provider business mailing address

11 NEW PROVIDENCE AVE
SUMMIT NJ
07901-1210
US

V. Phone/Fax

Practice location:
  • Phone: 908-251-3969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JUDITH TRACY
Title or Position: OWNER
Credential: NP
Phone: 908-251-3969