Provider Demographics
NPI:1235522194
Name:PRIMARY CARE PARTNERS, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE PARTNERS, LLC
Other - Org Name:BLOOMRIDGE PEDIATRICS-PCP AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-782-3300
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:399 HOOVER AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3924
Practice Address - Country:US
Practice Address - Phone:973-748-9500
Practice Address - Fax:973-748-9492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty