Provider Demographics
NPI:1356484687
Name:FAMILY PHYSICIANS AT BURLINGTON
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS AT BURLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-572-0809
Mailing Address - Street 1:1816 MOUNT HOLLY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4718
Mailing Address - Country:US
Mailing Address - Phone:609-747-0870
Mailing Address - Fax:609-747-0877
Practice Address - Street 1:1816 MOUNT HOLLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4718
Practice Address - Country:US
Practice Address - Phone:609-747-0870
Practice Address - Fax:609-747-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61656204E00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2149819OtherAETNA
NJ2149819OtherAETNA
NJ689545Medicare ID - Type Unspecified
NJ6547001Medicare ID - Type Unspecified