Provider Demographics
NPI:1659844884
Name:PRIME MD, PC
Entity Type:Organization
Organization Name:PRIME MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:ASHWIN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-361-0622
Mailing Address - Street 1:300 MAIN ST # 765
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2369
Mailing Address - Country:US
Mailing Address - Phone:352-361-0622
Mailing Address - Fax:
Practice Address - Street 1:115 ROUTE 206
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:352-207-4949
Practice Address - Fax:201-304-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty