Provider Demographics
NPI:1578640538
Name:ELMWOOD FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:ELMWOOD FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:HETAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-983-9939
Mailing Address - Street 1:777 ROUTE 70 EAST
Mailing Address - Street 2:SUITE G-101
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2345
Mailing Address - Country:US
Mailing Address - Phone:856-983-9939
Mailing Address - Fax:856-983-9936
Practice Address - Street 1:777 ROUTE 70 EAST
Practice Address - Street 2:SUITE G-101
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2345
Practice Address - Country:US
Practice Address - Phone:856-983-9939
Practice Address - Fax:856-983-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045021Medicaid
O86404Medicare UPIN
NJ0045021Medicaid
O86404Medicare UPIN