Provider Demographics
NPI:1164816492
Name:PRIME HEALTH MEDICAL LLC.
Entity Type:Organization
Organization Name:PRIME HEALTH MEDICAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REMADEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-679-0536
Mailing Address - Street 1:1129 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7127
Mailing Address - Country:US
Mailing Address - Phone:973-500-2686
Mailing Address - Fax:973-500-2686
Practice Address - Street 1:1129 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7127
Practice Address - Country:US
Practice Address - Phone:973-500-2686
Practice Address - Fax:973-500-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08661900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty