Provider Demographics
NPI:1437203874
Name:TABERNACLE FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:TABERNACLE FAMILY PHYSICIANS LLC
Other - Org Name:TABERNACLE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARAG
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-268-0707
Mailing Address - Street 1:1529 ROUTE 206
Mailing Address - Street 2:SUITE L
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8801
Mailing Address - Country:US
Mailing Address - Phone:609-268-0707
Mailing Address - Fax:609-268-7191
Practice Address - Street 1:1529 ROUTE 206
Practice Address - Street 2:SUITE L
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-8801
Practice Address - Country:US
Practice Address - Phone:609-268-0707
Practice Address - Fax:609-268-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ=========OtherTAX ID