Provider Demographics
NPI:1780915876
Name:PAPPAS FAMILY MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:PAPPAS FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-551-2003
Mailing Address - Street 1:1006 COMMONS WAY
Mailing Address - Street 2:BLDG G
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6429
Mailing Address - Country:US
Mailing Address - Phone:732-551-2003
Mailing Address - Fax:732-551-2033
Practice Address - Street 1:1006 COMMONS WAY
Practice Address - Street 2:BLDG G
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6429
Practice Address - Country:US
Practice Address - Phone:732-551-2003
Practice Address - Fax:732-551-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ174262Medicare PIN