Provider Demographics
NPI:1659516706
Name:CONVENIENT FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:CONVENIENT FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-750-5555
Mailing Address - Street 1:240 WILLIAM LIVINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7697
Mailing Address - Country:US
Mailing Address - Phone:732-750-5555
Mailing Address - Fax:732-750-5550
Practice Address - Street 1:613 RIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:MONMOUTH JCT
Practice Address - State:NJ
Practice Address - Zip Code:08852-2650
Practice Address - Country:US
Practice Address - Phone:732-329-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068150207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty