Provider Demographics
NPI:1255317046
Name:ELIZABETH PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:ELIZABETH PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-436-9494
Mailing Address - Street 1:240 WILLIAMSON ST STE 506
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3673
Mailing Address - Country:US
Mailing Address - Phone:908-436-9494
Mailing Address - Fax:908-436-9299
Practice Address - Street 1:240 WILLIAMSON ST STE 506
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3673
Practice Address - Country:US
Practice Address - Phone:908-436-9494
Practice Address - Fax:908-436-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7384904Medicaid
NJ071301Medicare ID - Type Unspecified
NJ7384904Medicaid