Healthcare Provider Details

I. General information

NPI: 1548364177
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES AT WASHINGTON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 FRIES MILL RD STE N-3
TURNERSVILLE NJ
08012-2015
US

IV. Provider business mailing address

188 FRIES MILL RD SUITE N-3
TURNERSVILLE NJ
08012-2015
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-8000
  • Fax: 856-875-8494
Mailing address:
  • Phone: 856-875-8000
  • Fax: 856-875-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L VENUTI
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 856-875-8000