Provider Demographics
NPI:1124002779
Name:BERLIN FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:BERLIN FAMILY PRACTICE ASSOCIATES
Other - Org Name:JOHN A LARATTA DO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-767-0078
Mailing Address - Street 1:23 HARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009
Mailing Address - Country:US
Mailing Address - Phone:856-767-0078
Mailing Address - Fax:856-767-3662
Practice Address - Street 1:23 HARKER AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:856-767-0078
Practice Address - Fax:856-767-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB064541261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2863308Medicaid
NJ2863308Medicaid
NJ051160Medicare ID - Type Unspecified