Provider Demographics
NPI:1649222373
Name:WINSLOW PRIMARY CARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:WINSLOW PRIMARY CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-985-2500
Mailing Address - Street 1:524 WILLIAMSTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1824
Mailing Address - Country:US
Mailing Address - Phone:856-728-1181
Mailing Address - Fax:856-728-1182
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1824
Practice Address - Country:US
Practice Address - Phone:856-728-1181
Practice Address - Fax:856-728-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04248000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54055Medicare UPIN
NJ095086Medicare ID - Type Unspecified