Healthcare Provider Details

I. General information

NPI: 1528108917
Provider Name (Legal Business Name): BUENA FAMILY PRACTICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HARDING HWY
RICHLAND NJ
08350-0310
US

IV. Provider business mailing address

1315 HARDING HIGHWAY PO BOX 310
RICHLAND NJ
08350
US

V. Phone/Fax

Practice location:
  • Phone: 856-697-0300
  • Fax:
Mailing address:
  • Phone: 856-697-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB64919
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB38680
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB40881
License Number StateNJ

VIII. Authorized Official

Name: JOHN A PIROLLI
Title or Position: PARTNER
Credential:
Phone: 856-697-0300