Provider Demographics
NPI:1104988773
Name:CENTER FOR PRIMARY CARE & GASTROENTEROLOGY LLC
Entity type:Organization
Organization Name:CENTER FOR PRIMARY CARE & GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAKET
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-755-3688
Mailing Address - Street 1:9 RENEE CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3634
Mailing Address - Country:US
Mailing Address - Phone:732-494-0964
Mailing Address - Fax:908-755-3788
Practice Address - Street 1:904 OAK TREE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5126
Practice Address - Country:US
Practice Address - Phone:908-755-3688
Practice Address - Fax:908-755-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06520900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7959508Medicaid
NJ028156Medicare ID - Type Unspecified
NJ7959508Medicaid