Provider Demographics
NPI:1013119122
Name:ALTMAN AND GERETY FAMILY MEDICAL
Entity type:Organization
Organization Name:ALTMAN AND GERETY FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-629-7006
Mailing Address - Street 1:188 FRIES MILL RD
Mailing Address - Street 2:SUITE E-3
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2015
Mailing Address - Country:US
Mailing Address - Phone:856-629-7006
Mailing Address - Fax:856-629-0077
Practice Address - Street 1:188 FRIES MILL RD
Practice Address - Street 2:SUITE E-3
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:856-629-7006
Practice Address - Fax:856-629-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO63661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8881308Medicaid
NJ8881308Medicaid
NJH05593Medicare UPIN