Provider Demographics
NPI:1770833279
Name:SOMERSET FAMILY PRACTICE
Entity Type:Organization
Organization Name:SOMERSET FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOJY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-685-2584
Mailing Address - Street 1:110 REHILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-685-2584
Mailing Address - Fax:
Practice Address - Street 1:110 REHILL AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-685-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMERSET MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8488002Medicaid
NJ8488002Medicaid