Healthcare Provider Details

I. General information

NPI: 1740247964
Provider Name (Legal Business Name): TRENTON FAMILY PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WEST STATESTREET
TRENTON NJ
08618
US

IV. Provider business mailing address

22 NORTH FRANKLIN AVENUE 2ND FLOOR
PLEASANTVILLE NJ
08232
US

V. Phone/Fax

Practice location:
  • Phone: 609-392-2585
  • Fax: 609-392-1448
Mailing address:
  • Phone: 609-272-0655
  • Fax: 609-272-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA59582
License Number StateNJ

VIII. Authorized Official

Name: JON M. REGIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-272-0655