Pedersen Family Medicine, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB09405100 Issued in NJ

Legal business name

PEDERSEN FAMILY MEDICINE, LLC

Practice address

1450 E Chestnut Ave
Building 3, Suite D
Vineland, NJ 08361-8467

Phone

(856) 692-0050

Fax

(856) 692-0081

NPI assigned

Sep 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel A Pedersen, D.O.

Title

Sole Member

Phone

(856) 630-5506

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441670400000",
    "number": "1497123418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2743 BETHPAGE CT",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083617741",
            "telephone_number": "856-630-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 E CHESTNUT AVE",
            "address_2": "BUILDING 3, SUITE D",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083618467",
            "telephone_number": "856-692-0050",
            "fax_number": "856-692-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERSEN FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2015-09-08",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "856-630-5506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB09405100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond K Patterson, M.D.
• Paul Minsky
• Magelende S Paviera, MSN, RN, AGNP-NC
• Ian Michael Pawasarat, DO
• Ryan Pearson
• Pediatric Associates LLC
• Pediatric Dentistry of South Jersey, P.C.
• Iris Perez, FNP
• Timothy Perkins, LCSW
• David Robert Pernelli, M.D.

• Family Medicine Physician in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.