Provider Demographics
NPI:1508933516
Name:MOUNT LAUREL PRIMARY CARE PHYSICIANS, PC
Entity Type:Organization
Organization Name:MOUNT LAUREL PRIMARY CARE PHYSICIANS, PC
Other - Org Name:BESEN GOLDSTEIN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:856-866-1557
Mailing Address - Street 1:1000 BIRCHFIELD DRIVE
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-866-1557
Mailing Address - Fax:856-231-7955
Practice Address - Street 1:1000 BIRCHFIELD DRIVE
Practice Address - Street 2:SUITE 1004
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-866-1557
Practice Address - Fax:856-231-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077800Medicare PIN