Provider Demographics
NPI:1275619413
Name:FAMILY CARE PA
Entity Type:Organization
Organization Name:FAMILY CARE PA
Other - Org Name:JOHN CHAFOS MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:CHAFOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-968-8832
Mailing Address - Street 1:257 RT 22 EAST
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812
Mailing Address - Country:US
Mailing Address - Phone:732-968-8832
Mailing Address - Fax:732-968-2187
Practice Address - Street 1:257 RT 22 EAST
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812
Practice Address - Country:US
Practice Address - Phone:732-968-8832
Practice Address - Fax:732-968-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05399400207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA05399400OtherLICENSE NUMBER
NJ4378170001Medicare PIN