1669814141 NPI number — PRIMARY CARE PARTNERS, LLC

Table of content: (NPI 1669814141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669814141 NPI number — PRIMARY CARE PARTNERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE PARTNERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED PRIMARY CARE- PRIMARY CARE PARTNERS AFFILIATE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669814141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-6403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-3300
Provider Business Mailing Address Fax Number:
856-504-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 SOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FANWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07023-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-889-8700
Provider Business Practice Location Address Fax Number:
908-889-7799
Provider Enumeration Date:
07/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHULKIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
973-971-7165

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com