Provider Demographics
NPI:1740306877
Name:NJ PRIMARY CARE ASSOCIATES, PC
Entity type:Organization
Organization Name:NJ PRIMARY CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LALITHA
Authorized Official - Middle Name:VENKAT
Authorized Official - Last Name:GUMIDYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-780-2221
Mailing Address - Street 1:509 STILLWELLS CORNER ROAD
Mailing Address - Street 2:SUITE # E-8
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-780-2221
Mailing Address - Fax:732-780-2292
Practice Address - Street 1:509 STILLWELLS CORNER RD
Practice Address - Street 2:SUITE # E-8
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-780-2221
Practice Address - Fax:732-780-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083069VAZMedicare ID - Type Unspecified
NJI16049Medicare UPIN