Provider Demographics
NPI:1003080169
Name:ANNANDALE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:ANNANDALE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SACCHIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-314-1139
Mailing Address - Street 1:56 PAYNE RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-3262
Mailing Address - Country:US
Mailing Address - Phone:908-238-0100
Mailing Address - Fax:908-238-0951
Practice Address - Street 1:56 PAYNE RD
Practice Address - Street 2:SUITE 21
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-3262
Practice Address - Country:US
Practice Address - Phone:908-238-0100
Practice Address - Fax:908-238-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07764100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care