Provider Demographics
NPI:1942233747
Name:PRIMARY CARE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-667-4402
Mailing Address - Street 1:PO BOX 1939
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-1939
Mailing Address - Country:US
Mailing Address - Phone:973-743-2331
Mailing Address - Fax:973-743-1441
Practice Address - Street 1:187 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2311
Practice Address - Country:US
Practice Address - Phone:973-667-4402
Practice Address - Fax:973-667-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20175207Q00000X
NJMA059660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0209513001OtherAMERIHEALTH
NJ5410509Medicaid
NJ110078758OtherRRMEDICARE
NJ110078758OtherRRMEDICARE
NJE37049Medicare UPIN