Provider Demographics
NPI:1194997304
Name:CENTER FOR PRIMARY CARE MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR PRIMARY CARE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-436-5900
Mailing Address - Street 1:4065 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5243
Mailing Address - Country:US
Mailing Address - Phone:609-436-5900
Mailing Address - Fax:609-452-0222
Practice Address - Street 1:4065 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-5243
Practice Address - Country:US
Practice Address - Phone:609-436-5900
Practice Address - Fax:609-452-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124933Medicare PIN
NJ6208850001Medicare NSC