Provider Demographics
NPI:1528108917
Name:BUENA FAMILY PRACTICE CENTER LLC
Entity type:Organization
Organization Name:BUENA FAMILY PRACTICE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIROLLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-697-0300
Mailing Address - Street 1:1315 HARDING HIGHWAY
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:RICHLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08350
Mailing Address - Country:US
Mailing Address - Phone:856-697-0300
Mailing Address - Fax:
Practice Address - Street 1:1315 HARDING HWY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:NJ
Practice Address - Zip Code:08350-0310
Practice Address - Country:US
Practice Address - Phone:856-697-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB64919207Q00000X
NJMB38680207R00000X
NJMB40881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0115968001OtherAMERIHEALTH
NJ552614OtherAETNA
NJCF1937OtherRAILROAD MEDICARE
NJ1528108917OtherMEDICARE NPI
NJ3423603Medicaid
NJ=========OtherHORIZON NJ HEALTH
NJ1528108917OtherMEDICARE NPI
NJ3423603Medicaid