Provider Demographics
NPI:1477811107
Name:BORDENTOWN FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:BORDENTOWN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISHE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-298-2992
Mailing Address - Street 1:163 ROUTE 130
Mailing Address - Street 2:BLDG. 1 SUITE B
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2248
Mailing Address - Country:US
Mailing Address - Phone:609-298-2992
Mailing Address - Fax:609-291-8359
Practice Address - Street 1:163 ROUTE 130
Practice Address - Street 2:BLDG. 1 SUITE B
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2248
Practice Address - Country:US
Practice Address - Phone:609-298-2992
Practice Address - Fax:609-291-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50962261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8288402Medicaid
NJ036612Medicare UPIN