Provider Demographics
NPI:1093849739
Name:ROUTE 53 MEDICAL FAMILY PRACTICE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ROUTE 53 MEDICAL FAMILY PRACTICE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-359-8859
Mailing Address - Street 1:891 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2733
Mailing Address - Country:US
Mailing Address - Phone:973-359-8859
Mailing Address - Fax:973-359-8860
Practice Address - Street 1:891 TABOR RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2733
Practice Address - Country:US
Practice Address - Phone:973-359-8859
Practice Address - Fax:973-359-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037617Medicare PIN