Provider Demographics
NPI:1093453292
Name:PRIMARY DIAGNOSTICS MEDICAL GROUP OF NEW JERSEY P.C.
Entity Type:Organization
Organization Name:PRIMARY DIAGNOSTICS MEDICAL GROUP OF NEW JERSEY P.C.
Other - Org Name:PRIMARY. HEALTH MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL LEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FADUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-557-5361
Mailing Address - Street 1:595 PACIFIC AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4685
Mailing Address - Country:US
Mailing Address - Phone:855-970-3223
Mailing Address - Fax:
Practice Address - Street 1:595 PACIFIC AVE FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4685
Practice Address - Country:US
Practice Address - Phone:855-970-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty