Healthcare Provider Details

I. General information

NPI: 1013011659
Provider Name (Legal Business Name): CENTRAL JERSEY FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 PARK AVE
SOUTH PLAINFIELD NJ
07080-5522
US

IV. Provider business mailing address

1810 PARK AVE
SOUTH PLAINFIELD NJ
07080-5522
US

V. Phone/Fax

Practice location:
  • Phone: 908-561-4914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMA022782
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT CARDINALE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 908-756-7200