=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447346788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICINE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 12TH ST MADISON AVE
-----------------------------------------------------
City | HAMMONTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-561-0128
-----------------------------------------------------
Fax | 609-567-8467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 12TH ST MADISON AVE
-----------------------------------------------------
City | HAMMONTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-561-0128
-----------------------------------------------------
Fax | 609-567-8467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL ADMIN ASST
-----------------------------------------------------
Name | MRS. LINDA ROSE BARTALONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-561-0128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------