Provider Demographics
NPI:1821477431
Name:CONVENIENT PRIMARY CARE
Entity Type:Organization
Organization Name:CONVENIENT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-404-0121
Mailing Address - Street 1:48 S NEW YORK RD SUITE B-3
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-404-0121
Mailing Address - Fax:
Practice Address - Street 1:48 S NEW YORK RD SUITE B-3
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-404-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08815700207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ273265712OtherTAX ID