Glendora Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB06092600 Issued in NJ

Legal business name

GLENDORA FAMILY PRACTICE LLC

Practice address

1300 Black Horse Pike
Glendora, NJ 08029-1308

Phone

(856) 939-2828

Fax

(856) 939-5057

NPI assigned

May 23, 2006

Last updated

Jan 2, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Ira Blank, DONPI 1891786455

Title

President

Phone

(856) 939-2828

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Benjamin Ira Blank, D.O.

  • Family Medicine Physician
  • Glendora, NJ
  • NPI 1891786455
  Authorized official Same address or phone

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230854400000",
    "number": "1750336392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 BLACK HORSE PIKE",
            "city": "GLENDORA",
            "state": "NJ",
            "postal_code": "080291308",
            "telephone_number": "856-939-2828",
            "fax_number": "856-939-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BLACK HORSE PIKE",
            "city": "GLENDORA",
            "state": "NJ",
            "postal_code": "080291308",
            "telephone_number": "856-939-2828",
            "fax_number": "856-939-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDORA FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-01-02",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "IRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-939-2828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB06092600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Dulin, PTA
• Shane Famille, PT, ATC
• Forward Counseling LLC
• Karen M Frame, P.T.
• Quanhao Fu
• Gail Judith Hallof, CRNA
• Zoya Kakar, RPH
• Bruce Kerensky, DDS
• Ty Lam
• Valerie Anne McGuigan

• Family Medicine Physician in Glendora, NJ
• Providers in Glendora, 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 Jan 2, 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.