Family Medicine of Lindenwold LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA04393800 Issued in NJ

Legal business name

FAMILY MEDICINE OF LINDENWOLD LLC

Practice address

409 E Gibbsboro Rd
Lindenwold, NJ 08021

Phone

(856) 309-0100

Fax

(856) 309-8827

NPI assigned

Aug 12, 2006

Organization subpart

No

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

Authorized official

Name

David Louis Neidorf, MD

Title

Owner

Phone

(856) 309-0100

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1679585178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 E GIBBSBORO RD",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "08021",
            "telephone_number": "856-309-0100",
            "fax_number": "856-309-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 E GIBBSBORO RD",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "08021",
            "telephone_number": "856-309-0100",
            "fax_number": "856-309-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF LINDENWOLD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "NEIDORF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-309-0100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04393800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0887404",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.