Provider Demographics
NPI:1821254798
Name:FAMILY COMMUNITY MEDICINE LLC
Entity Type:Organization
Organization Name:FAMILY COMMUNITY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:SJOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-671-0093
Mailing Address - Street 1:8 TINDALL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2740
Mailing Address - Country:US
Mailing Address - Phone:732-671-0093
Mailing Address - Fax:732-671-0226
Practice Address - Street 1:8 TINDALL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2740
Practice Address - Country:US
Practice Address - Phone:732-671-0093
Practice Address - Fax:732-671-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0626400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS98269Medicare UPIN