Provider Demographics
NPI:1306907886
Name:CEDAR BROOK FAMILY PRACTICE PC
Entity type:Organization
Organization Name:CEDAR BROOK FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-567-2101
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:CEDAR BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08018-0327
Mailing Address - Country:US
Mailing Address - Phone:609-567-2101
Mailing Address - Fax:609-704-9351
Practice Address - Street 1:187 S ROUTE 73
Practice Address - Street 2:SUITE B
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9423
Practice Address - Country:US
Practice Address - Phone:609-567-2101
Practice Address - Fax:609-704-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB055669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty