Provider Demographics
NPI:1336277177
Name:CAMDEN FAMILY MEDICINE, A PROF CORP
Entity Type:Organization
Organization Name:CAMDEN FAMILY MEDICINE, A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-541-6800
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08101-0556
Mailing Address - Country:US
Mailing Address - Phone:856-541-6800
Mailing Address - Fax:856-541-1636
Practice Address - Street 1:639 COOPER ST
Practice Address - Street 2:HEALTH CENTER
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1116
Practice Address - Country:US
Practice Address - Phone:856-541-6800
Practice Address - Fax:856-541-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068543Medicare PIN