Provider Demographics
NPI:1669770533
Name:CLEMENTON FAMILY PRACTICE & AMBULATORY CARE
Entity type:Organization
Organization Name:CLEMENTON FAMILY PRACTICE & AMBULATORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-566-8325
Mailing Address - Street 1:657 BLACKWOOD CLEMENTON ROAD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021
Mailing Address - Country:US
Mailing Address - Phone:856-566-8325
Mailing Address - Fax:856-566-8326
Practice Address - Street 1:657 BLACKWOOD CLEMENTON ROAD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-566-8325
Practice Address - Fax:856-566-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty