| The Estaugh T/a Medford Leas | |
|
1 Medford Leas Medford NJ 08055-2254 | |
| (609) 654-3005 | |
| (609) 654-7894 |
| Full Name | The Estaugh T/a Medford Leas |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Medford Leas, Medford, New Jersey |
| Authorized Official Name and Position | Jeremy M Vickers (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6096543009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Estaugh T/a Medford Leas 1 Medford Leas Medford NJ 08055-2254 Ph: (609) 654-3005 | The Estaugh T/a Medford Leas 1 Medford Leas Medford NJ 08055-2254 Ph: (609) 654-3005 |
| NPI Number | 1659309524 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 07/15/2022 |
| Medicare PECOS PAC ID | 6608833512 |
|---|---|
| Medicare Enrollment ID | O20041213000560 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659309524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Terry L Fazio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720253743 PECOS PAC ID: 3375435738 Enrollment ID: I20040329001291 |
| Provider Name | Jeffrey A Ranalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639120462 PECOS PAC ID: 1759376437 Enrollment ID: I20040426001482 |
| Provider Name | Loren A Firstenberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033231873 PECOS PAC ID: 9638129877 Enrollment ID: I20050126000410 |
| Provider Name | James Charles Damico |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457353088 PECOS PAC ID: 0648270439 Enrollment ID: I20100322000537 |
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Pineland Plaza Family Practice, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 617 Stokes Rd, Suite 9, Medford, NJ 08055 Phone: 609-953-8080 Fax: 609-953-2133 | |
Advocare Medford Station Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 69 N Main St, Medford, NJ 08055 Phone: 609-953-9000 Fax: 609-953-9696 | |
Waldron & Holton Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 69 North Main Street, Medford, NJ 08055 Phone: 609-953-9000 Fax: 609-953-9696 |