Provider Demographics
NPI:1407381072
Name:PRIMERA HEALTH AND WELLNESS COMPANY
Entity Type:Organization
Organization Name:PRIMERA HEALTH AND WELLNESS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:SUSHIL
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-904-7564
Mailing Address - Street 1:20430 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 7TH AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1803
Practice Address - Country:US
Practice Address - Phone:678-904-7564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty