Woodbine Family Medical

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MB61909 Issued in NJ

Legal business name

WOODBINE FAMILY MEDICAL

Practice address

713 Dehirsch Ave
Woodbine, NJ 08270-2339

Phone

(609) 861-4241

Fax

(609) 861-1071

NPI assigned

May 3, 2011

Organization subpart

No

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

Authorized official

Name

Doris Jacob

Title

Owner

Phone

(609) 861-4241

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra L Russo, DO

  • Family Medicine Physician
  • Woodbine, NJ
  • NPI 1467404251
  NPD (past)
• Lisa K. Bork, APN

  • Family Nurse Practitioner
  • Ocala, FL
  • NPI 1013008390
  NPD (past)

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1962794420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 DEHIRSCH AVE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "082702339",
            "telephone_number": "609-861-4241",
            "fax_number": "609-861-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 DEHIRSCH AVE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "082702339",
            "telephone_number": "609-861-4241",
            "fax_number": "609-861-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBINE FAMILY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-861-4241"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB61909",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NN1202500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7011008",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Upper Township School District
• Kyisha Latora Wing
• Lauren Witkowsky, RN
• Woodbine Board of Education
• Woodbine Dental PA
• Woodbine Pharmacy Inc (Family Health and Presc Center)
• Kristin Zintner, RN

• Family Medicine Physician in Woodbine, NJ
• Providers in Woodbine, 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 May 3, 2011; 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.