Provider Demographics
NPI:1740055714
Name:SM TRINITY PRIMARY CARE LLC
Entity type:Organization
Organization Name:SM TRINITY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOREGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-672-3140
Mailing Address - Street 1:904 OAK TREE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:S PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5126
Mailing Address - Country:US
Mailing Address - Phone:732-672-3140
Mailing Address - Fax:
Practice Address - Street 1:904 OAK TREE AVE STE F
Practice Address - Street 2:
Practice Address - City:S PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5126
Practice Address - Country:US
Practice Address - Phone:732-672-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty