Provider Demographics
NPI:1588014922
Name:PRIME HEALTH SERVICES
Entity Type:Organization
Organization Name:PRIME HEALTH SERVICES
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 1:393 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3001
Mailing Address - Country:US
Mailing Address - Phone:908-721-2153
Mailing Address - Fax:
Practice Address - Street 1:393 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3001
Practice Address - Country:US
Practice Address - Phone:908-721-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08162900OtherMEDICAL LICENSE