Provider Demographics
NPI:1962485649
Name:PARKSIDE URGENT CARE, INC
Entity Type:Organization
Organization Name:PARKSIDE URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OBASI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-882-5200
Mailing Address - Street 1:1450 PARKSIDE AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2946
Mailing Address - Country:US
Mailing Address - Phone:609-882-5200
Mailing Address - Fax:609-882-0370
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-882-5200
Practice Address - Fax:609-882-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care