Basic Information
| Provider Information | |||||||||
| NPI: | 1578509097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CINNAMINSON FAMILY PRACTICE GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WYNWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568294755 | ||||||||
| FaxNumber: | 8567860505 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 WYNWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568294755 | ||||||||
| FaxNumber: | 8567860505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REINHART | ||||||||
| AuthorizedOfficialFirstName: | MARIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8568294755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.