Provider Demographics
NPI:1528444254
Name:THE OSBORN FAMILY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:THE OSBORN FAMILY HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-757-3706
Mailing Address - Street 1:1601 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3109
Mailing Address - Country:US
Mailing Address - Phone:856-757-3700
Mailing Address - Fax:856-365-7972
Practice Address - Street 1:1601 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3109
Practice Address - Country:US
Practice Address - Phone:856-757-3700
Practice Address - Fax:856-365-7972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OSBORN FAMILY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty