Provider Demographics
NPI:1003196858
Name:PRIMARY CARE PARTNERS, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE PARTNERS, LLC
Other - Org Name:SCADUTO & RENZ MDS- PRIMARY CARE PARTNERS AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-971-5450
Mailing Address - Street 1:PO BOX 2403
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-6403
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1166
Practice Address - Country:US
Practice Address - Phone:973-335-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-25
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty