Provider Demographics
NPI:1083045694
Name:AM PM PRIMARY CARE
Entity type:Organization
Organization Name:AM PM PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-923-1177
Mailing Address - Street 1:19 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2324
Mailing Address - Country:US
Mailing Address - Phone:201-387-0177
Mailing Address - Fax:201-966-0588
Practice Address - Street 1:19 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2324
Practice Address - Country:US
Practice Address - Phone:201-387-0177
Practice Address - Fax:201-966-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06949100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care