=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861483299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHURST FAMILY PHYSICIANS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1561 ROUTE 38 SUITE 6
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-702-5510
-----------------------------------------------------
Fax | 609-267-0642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1561 ROUTE 38 SUITE 6A
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-702-5510
-----------------------------------------------------
Fax | 609-267-0642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT J. BROSS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-702-5510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------