Provider Demographics
NPI:1609178573
Name:FAMILY HEALTH PROVIDERS, LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:973-207-1147
Mailing Address - Street 1:PO BOX 2042
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2042
Mailing Address - Country:US
Mailing Address - Phone:973-207-1147
Mailing Address - Fax:
Practice Address - Street 1:450 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-4218
Practice Address - Country:US
Practice Address - Phone:973-207-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty