Provider Demographics
NPI:1689142093
Name:PRIMARY CARE OF MERCER AND MONMOUTH COUNTY
Entity Type:Organization
Organization Name:PRIMARY CARE OF MERCER AND MONMOUTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMING
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:609-838-7111
Mailing Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3701
Mailing Address - Country:US
Mailing Address - Phone:609-838-7111
Mailing Address - Fax:
Practice Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD STE 304
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3701
Practice Address - Country:US
Practice Address - Phone:609-838-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450316262OtherTAX ID