Provider Demographics
NPI:1861590978
Name:MEETINGHOUSE FAMILY PHYSICIANS PA
Entity type:Organization
Organization Name:MEETINGHOUSE FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONZELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-596-9050
Mailing Address - Street 1:105 EVESBORO MEDFORD RD STE I
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3865
Mailing Address - Country:US
Mailing Address - Phone:856-596-9050
Mailing Address - Fax:856-596-0320
Practice Address - Street 1:105 EVESBORO MEDFORD RD STE I
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3865
Practice Address - Country:US
Practice Address - Phone:856-596-9050
Practice Address - Fax:856-596-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0368900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10004OtherAETNA
0837097001OtherAMERIHEALTH
CH5856Medicare PIN
10004OtherAETNA