Provider Demographics
NPI:1497513246
Name:PRIME HEALTH GROUP LLC
Entity Type:Organization
Organization Name:PRIME HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSADURGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-721-2153
Mailing Address - Street 1:208 LENOX AVE # 154
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 LENOX AVE # 154
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5120
Practice Address - Country:US
Practice Address - Phone:732-443-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty