Healthcare Provider Details

I. General information

NPI: 1578534475
Provider Name (Legal Business Name): COVENTRY FAMILY PRACTICE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY
PHILLIPSBURG NJ
08865-2748
US

IV. Provider business mailing address

755 MEMORIAL PKWY
PHILLIPSBURG NJ
08865-2748
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-6303
  • Fax: 908-454-2289
Mailing address:
  • Phone: 908-454-6303
  • Fax: 908-454-2289

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: DR. RAYMOND S BUCH
Title or Position: DIRECTOR
Credential: MD
Phone: 908-454-6303