Provider Demographics
NPI:1063602696
Name:PRIMARY CARE MEDICINE, LLC
Entity type:Organization
Organization Name:PRIMARY CARE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATARSEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-2003
Mailing Address - Street 1:PO BOX 36255
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07188-0001
Mailing Address - Country:US
Mailing Address - Phone:201-797-2003
Mailing Address - Fax:201-797-7003
Practice Address - Street 1:20-19 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2320
Practice Address - Country:US
Practice Address - Phone:201-797-2003
Practice Address - Fax:201-797-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096656Medicare PIN