Provider Demographics
NPI:1609021401
Name:VINTAGE FAMILY CARE,LLC.
Entity Type:Organization
Organization Name:VINTAGE FAMILY CARE,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALLIT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-369-6700
Mailing Address - Street 1:378 S BRANCH RD
Mailing Address - Street 2:BUILDING 3 SUITE 302
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-8207
Mailing Address - Country:US
Mailing Address - Phone:908-369-6700
Mailing Address - Fax:908-369-1515
Practice Address - Street 1:378 S BRANCH RD
Practice Address - Street 2:BUILDING 3 SUITE 302
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8207
Practice Address - Country:US
Practice Address - Phone:908-369-6700
Practice Address - Fax:908-369-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05323400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
666636OtherMEDICARE LEGACY NUMBER
=========OtherAETNA
=========OtherHORIZON
=========OtherUNITED/OXFORD
=========OtherHORIZON