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NPI Code Detail

MEDICARE: PINE STREET FAMILY PRACTICE

MEDICARE: PINE STREET FAMILY PRACTICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1437103033
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE STREET FAMILY PRACTICE
Provider Business Mailing Address
First Line : 220 PINE ST
Second Line :
City : WILLIAMSTOWN
State : NJ
Zip : 08094-1137
Country : US
Telephone Number : 856-629-7436
Fax Number : 856-875-4742
Provider Business Practice Location Address
First Line : 220 PINE ST
Second Line :
City : WILLIAMSTOWN
State : NJ
Zip : 08094-1137
Country : US
Telephone Number : 856-629-7436
Fax Number : 856-875-4742
Authorized Official
Title or Position : PHYSICIAN/PRESIDENT
Name : DR. LEE ANN VAN HOUTEN-SAUTER
Credential : D.O.
Telephone Number : 856-629-7436
Provider Enumeration Date : 05/19/2006
Last Update Date : 08/22/2020

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Directions to “PINE STREET FAMILY PRACTICE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.