| Codella Family Practice | |
|
1050 Galloping Hill Road Suite 102 Union NJ 07083 | |
| (908) 688-1550 | |
| (908) 688-1552 |
| Full Name | Codella Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1050 Galloping Hill Road, Union, New Jersey |
| Authorized Official Name and Position | Vincent Codella (PHYSICIAN) |
| Authorized Official Contact | 9086881550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Codella Family Practice 1050 Galloping Hill Road Suite 102 Union NJ 07083 Ph: (908) 688-1550 | Codella Family Practice 1050 Galloping Hill Road Suite 102 Union NJ 07083 Ph: (908) 688-1550 |
| NPI Number | 1871632075 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7012974322 |
|---|---|
| Medicare Enrollment ID | O20041217000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871632075 | NPI | - | NPPES |
| 0047171 | Medicaid | NJ | |
| 0047198 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MB074566 (New Jersey) | Primary |
| Provider Name | Vincent A Codella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134111248 PECOS PAC ID: 4183692866 Enrollment ID: I20040921000222 |
| Provider Name | Dawn Muriel A Guzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295203305 PECOS PAC ID: 8628314960 Enrollment ID: I20190108002345 |
| Provider Name | Angela M Beauchamp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265815385 PECOS PAC ID: 7517203581 Enrollment ID: I20190111001343 |
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