Provider Demographics
NPI:1841589884
Name:PRIMED HEALTH LLC
Entity Type:Organization
Organization Name:PRIMED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEON-WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-222-6545
Mailing Address - Street 1:10 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3825
Mailing Address - Country:US
Mailing Address - Phone:201-222-6545
Mailing Address - Fax:201-659-0510
Practice Address - Street 1:10 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3825
Practice Address - Country:US
Practice Address - Phone:201-222-6545
Practice Address - Fax:201-659-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05907400207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty