Provider Demographics
NPI:1063884088
Name:VILLAGE FAMILY MEDICAL
Entity type:Organization
Organization Name:VILLAGE FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRE
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-813-8200
Mailing Address - Street 1:1500 ROUTE 517
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2717
Mailing Address - Country:US
Mailing Address - Phone:908-813-8200
Mailing Address - Fax:908-813-8224
Practice Address - Street 1:1500 ROUTE 517
Practice Address - Street 2:SUITE 108
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2717
Practice Address - Country:US
Practice Address - Phone:908-813-8200
Practice Address - Fax:908-813-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05039300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty