Provider Demographics
NPI:1821024308
Name:ALL CARE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:ALL CARE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-427-0604
Mailing Address - Street 1:5 JENNY LANE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-1940
Mailing Address - Country:US
Mailing Address - Phone:973-427-0600
Mailing Address - Fax:973-427-0604
Practice Address - Street 1:245 DIAMOND BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-0000
Practice Address - Country:US
Practice Address - Phone:973-427-0600
Practice Address - Fax:973-427-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB064309207R00000X
NJ25MD06430900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6525600001Medicare NSC
NJ094180Medicare UPIN