Provider Demographics
NPI:1821482175
Name:NJ PRIMARY CARE PC
Entity Type:Organization
Organization Name:NJ PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GADHVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-902-0300
Mailing Address - Street 1:200 HUDSON ST STE 145
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311-1220
Mailing Address - Country:US
Mailing Address - Phone:201-360-0782
Mailing Address - Fax:
Practice Address - Street 1:500 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3421
Practice Address - Country:US
Practice Address - Phone:973-239-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08458400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0180998Medicaid