Provider Demographics
NPI:1982710356
Name:WINSLOW FAMILY PHYSICIANS, PA
Entity Type:Organization
Organization Name:WINSLOW FAMILY PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-767-8228
Mailing Address - Street 1:339 N ROUTE 73
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-767-8228
Mailing Address - Fax:856-753-7826
Practice Address - Street 1:339 N ROUTE 73
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-767-8228
Practice Address - Fax:856-753-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7545908Medicaid
NJ7545908Medicaid