Basic Information
| Provider Information | |||||||||
| NPI: | 1417366626 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUNTERDON MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COUNTY LINE FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3461 ROUTE 22 | ||||||||
| Address2: | |||||||||
| City: | BRANCHBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088766021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085346271 | ||||||||
| FaxNumber: | 9085264495 | ||||||||
| Practice Location | |||||||||
| Address1: | 3461 ROUTE 22 | ||||||||
| Address2: | |||||||||
| City: | BRANCHBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088766021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085346271 | ||||||||
| FaxNumber: | 9085264495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOSKINS | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9087886429 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.