Provider Demographics
NPI:1285370858
Name:TNJ DIRECT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:TNJ DIRECT PRIMARY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C, FNP-BC
Authorized Official - Phone:202-350-0801
Mailing Address - Street 1:1331 H ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4706
Mailing Address - Country:US
Mailing Address - Phone:202-350-0801
Mailing Address - Fax:202-989-1270
Practice Address - Street 1:1331 H ST NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4706
Practice Address - Country:US
Practice Address - Phone:202-350-0801
Practice Address - Fax:202-989-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty