Provider Demographics
NPI:1306178348
Name:SAINT CLARE'S PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:SAINT CLARE'S PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-983-5245
Mailing Address - Street 1:66 FORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1379
Mailing Address - Country:US
Mailing Address - Phone:973-983-1602
Mailing Address - Fax:973-983-1530
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 216
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-983-5602
Practice Address - Fax:973-627-2689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT CLARE'S COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08608900207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty