Provider Demographics
NPI:1801078779
Name:PRIMARY AND PREVENTATIVE INTERNAL MEDICINE OF CENTRAL NEW JERSEY, LLC
Entity type:Organization
Organization Name:PRIMARY AND PREVENTATIVE INTERNAL MEDICINE OF CENTRAL NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-721-0071
Mailing Address - Street 1:2045 US HIGHWAY 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2069
Mailing Address - Country:US
Mailing Address - Phone:732-721-0071
Mailing Address - Fax:732-721-7712
Practice Address - Street 1:2045 US HIGHWAY 35 SOUTH
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-721-0071
Practice Address - Fax:732-721-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119388Medicare PIN