Provider Demographics
NPI:1801194709
Name:PNJ PRIMARY CARE LLC
Entity type:Organization
Organization Name:PNJ PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-734-6621
Mailing Address - Street 1:14708 SUSAN MARIE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8614
Mailing Address - Country:US
Mailing Address - Phone:301-682-8888
Mailing Address - Fax:301-682-3515
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 186
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8337
Practice Address - Country:US
Practice Address - Phone:301-682-8888
Practice Address - Fax:301-682-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00286640261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD481191700Medicaid
MD481191700Medicaid
MDH745I361Medicare PIN