Provider Demographics
NPI:1700954476
Name:ETHERIDGE FAMILY MEDICINE, L.L.C.
Entity Type:Organization
Organization Name:ETHERIDGE FAMILY MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-246-0057
Mailing Address - Street 1:27 CLYDE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5039
Mailing Address - Country:US
Mailing Address - Phone:732-246-0057
Mailing Address - Fax:732-745-7070
Practice Address - Street 1:27 CLYDE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5039
Practice Address - Country:US
Practice Address - Phone:732-246-0057
Practice Address - Fax:732-745-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2311539001OtherAMERIHEALTH
2025674OtherAETNA
2K7104OtherACS HEALTHNET
P1087747OtherOXFORD
4197625010OtherCIGNA
8669281OtherUNITED HEALTHCARE