Provider Demographics
NPI:1437103033
Name:PINE STREET FAMILY PRACTICE
Entity Type:Organization
Organization Name:PINE STREET FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VAN HOUTEN-SAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-629-7436
Mailing Address - Street 1:220 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1137
Mailing Address - Country:US
Mailing Address - Phone:856-629-7436
Mailing Address - Fax:856-875-4742
Practice Address - Street 1:220 PINE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1137
Practice Address - Country:US
Practice Address - Phone:856-629-7436
Practice Address - Fax:856-875-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty