Provider Demographics
NPI:1992827141
Name:IDEAL FAMILY HEALTH, P.C.
Entity Type:Organization
Organization Name:IDEAL FAMILY HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBB-MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-568-1300
Mailing Address - Street 1:164 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1625
Mailing Address - Country:US
Mailing Address - Phone:201-568-1300
Mailing Address - Fax:201-568-1320
Practice Address - Street 1:291 S VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4632
Practice Address - Country:US
Practice Address - Phone:201-568-1300
Practice Address - Fax:201-568-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA064861OtherNEW JERSEY LICENSE