Provider Demographics
NPI:1053670216
Name:NEW PROVIDENCE FAMILY PRACTICE CORPORATION
Entity Type:Organization
Organization Name:NEW PROVIDENCE FAMILY PRACTICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:GIOVANNI
Authorized Official - Last Name:MARTINETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-771-9311
Mailing Address - Street 1:139 SOUTH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1999
Mailing Address - Country:US
Mailing Address - Phone:908-771-9311
Mailing Address - Fax:908-771-9302
Practice Address - Street 1:139 SOUTH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1999
Practice Address - Country:US
Practice Address - Phone:908-771-9311
Practice Address - Fax:908-771-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04919800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty