Provider Demographics
NPI:1538231964
Name:PLAZA FAMILY CARE PC
Entity type:Organization
Organization Name:PLAZA FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOCILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHA
Authorized Official - Phone:908-850-7816
Mailing Address - Street 1:657 WILLOW GROVE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1713
Mailing Address - Country:US
Mailing Address - Phone:908-850-7800
Mailing Address - Fax:908-850-7803
Practice Address - Street 1:657 WILLOW GROVE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1713
Practice Address - Country:US
Practice Address - Phone:908-850-7800
Practice Address - Fax:908-850-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02678000208000000X
NJ25MA04754600208000000X
NJ25MA05455400208000000X
NJ25MA08700100208000000X
NJ25MA06550000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003226Medicare PIN