Provider Demographics
NPI:1982218574
Name:PRIMARY HEALTH SERVICES
Entity Type:Organization
Organization Name:PRIMARY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASDUN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:732-534-1378
Mailing Address - Street 1:18 NATURES WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4339
Mailing Address - Country:US
Mailing Address - Phone:732-886-7372
Mailing Address - Fax:
Practice Address - Street 1:500 RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4719
Practice Address - Country:US
Practice Address - Phone:732-884-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty