Provider Demographics
NPI:1003847906
Name:SOUTH PLAINFIELD PRIMARY CARE
Entity type:Organization
Organization Name:SOUTH PLAINFIELD PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-756-7200
Mailing Address - Street 1:2509 PARK AVE
Mailing Address - Street 2:SUITE#1A
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5300
Mailing Address - Country:US
Mailing Address - Phone:908-756-8024
Mailing Address - Fax:908-561-4914
Practice Address - Street 1:2509 PARK AVE
Practice Address - Street 2:SUITE#1A
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5300
Practice Address - Country:US
Practice Address - Phone:908-756-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D0151696Medicaid
NJ634401Medicare PIN
NJ1D0151696Medicaid