Provider Demographics
NPI:1912956905
Name:FAMILY PHYSICIAN, LLC
Entity type:Organization
Organization Name:FAMILY PHYSICIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-206-8122
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-0454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4433
Practice Address - Country:US
Practice Address - Phone:201-689-1939
Practice Address - Fax:201-689-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07566000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070122T55Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
H85407Medicare UPIN