Healthcare Provider Details

I. General information

NPI: 1437203874
Provider Name (Legal Business Name): TABERNACLE FAMILY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 ROUTE 206 SUITE L
TABERNACLE NJ
08088-8801
US

IV. Provider business mailing address

1529 ROUTE 206 SUITE L
TABERNACLE NJ
08088-8801
US

V. Phone/Fax

Practice location:
  • Phone: 609-268-0707
  • Fax: 609-268-7191
Mailing address:
  • Phone: 609-268-0707
  • Fax: 609-268-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PARAG S PATEL
Title or Position: PARTNER
Credential: MD
Phone: 609-268-0707