Provider Demographics
NPI:1588765291
Name:GLENDALE PRIMARY CARE LLC
Entity type:Organization
Organization Name:GLENDALE PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-931-6950
Mailing Address - Street 1:9 W BROWNING RD # A
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2297
Mailing Address - Country:US
Mailing Address - Phone:856-931-6950
Mailing Address - Fax:856-931-6951
Practice Address - Street 1:9 W BROWNING RD # A
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2297
Practice Address - Country:US
Practice Address - Phone:856-931-6950
Practice Address - Fax:856-931-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07937100207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID