Provider Demographics
NPI:1295957769
Name:WASHINGTON FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:WASHINGTON FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:RAMONA
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-348-9173
Mailing Address - Street 1:137 SMITHFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2789
Mailing Address - Country:US
Mailing Address - Phone:973-348-9173
Mailing Address - Fax:908-271-6556
Practice Address - Street 1:191 US HIGHWAY 206
Practice Address - Street 2:SUITE 5
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9002
Practice Address - Country:US
Practice Address - Phone:973-584-0045
Practice Address - Fax:973-584-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07631200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1174678114OtherINDIVIDUAL NPI
NJ1174678114OtherINDIVIDUAL NPI