Basic Information
| Provider Information | |||||||||
| NPI: | 1740528520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMCARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080281639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568816117 | ||||||||
| FaxNumber: | 8568632816 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 MULLICA HILL RD | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080281700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568817495 | ||||||||
| FaxNumber: | 8568632816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 01/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | CANNADY | ||||||||
| AuthorizedOfficialFirstName: | SABRINA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 8564679344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0017205 | 05 | NJ | MEDICAID |