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General NPI Number Information
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NPI Number | 1609021401
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Entity Type | Organization
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Legal Business Name | VINTAGE FAMILY CARE,LLC.
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 378 S BRANCH RD BUILDING 3 SUITE 302
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-8207
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Country | US
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Telephone | 908-369-6700
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Fax | 908-369-1515
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Provider Business Mailing Address
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Address Line | 378 S BRANCH RD BUILDING 3 SUITE 302
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-8207
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Country | US
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Telephone | 908-369-6700
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Fax | 908-369-1515
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JANICE A HALLIT
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Credential | D.O.
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Telephone | 908-369-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB05323400
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License Number State | NJ
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