Provider Demographics
NPI:1972619807
Name:PRIMED MEDICAL CARE PC
Entity Type:Organization
Organization Name:PRIMED MEDICAL CARE PC
Other - Org Name:PRIMED MEDICA CARE PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVATHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-852-8484
Mailing Address - Street 1:616 WILLOW GROVE STREET
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1779
Mailing Address - Country:US
Mailing Address - Phone:908-852-8484
Mailing Address - Fax:908-852-4197
Practice Address - Street 1:616 WILLOW GROVE STREET
Practice Address - Street 2:UNIT 1A
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1779
Practice Address - Country:US
Practice Address - Phone:908-852-8484
Practice Address - Fax:908-852-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8684308Medicaid
NJ8684308Medicaid
NJ050733TNDMedicare ID - Type Unspecified