Provider Demographics
NPI:1982910055
Name:ADVANCED URGENT CARE OF LAWRENCEVILLE LLC
Entity Type:Organization
Organization Name:ADVANCED URGENT CARE OF LAWRENCEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKPARVARFARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-441-4267
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0957
Mailing Address - Country:US
Mailing Address - Phone:570-909-9989
Mailing Address - Fax:866-691-4201
Practice Address - Street 1:111 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08648-4307
Practice Address - Country:US
Practice Address - Phone:609-943-2071
Practice Address - Fax:609-943-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty