Basic Information
| Provider Information | |||||||||
| NPI: | 1528444254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE OSBORN FAMILY HEALTH CENTER, INC. | ||||||||
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| OtherOrganizationName: | THE OSBORN FAMILY HEALTH CENTER, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 HADDON AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567573700 | ||||||||
| FaxNumber: | 8563657972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 HADDON AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567573700 | ||||||||
| FaxNumber: | 8563657972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | CUILLA | ||||||||
| AuthorizedOfficialFirstName: | SHAWNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8567573706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE OSBORN FAMILY HEALTH CENTER, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.