Provider Demographics
NPI:1588687479
Name:PRIMARY MEDICAL CARE PROFESSIONAL
Entity type:Organization
Organization Name:PRIMARY MEDICAL CARE PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-673-9229
Mailing Address - Street 1:85 S JEFFERSON ST
Mailing Address - Street 2:STE.1
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1562
Mailing Address - Country:US
Mailing Address - Phone:973-677-3466
Mailing Address - Fax:973-677-2362
Practice Address - Street 1:85 S JEFFERSON ST
Practice Address - Street 2:STE. 3
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1562
Practice Address - Country:US
Practice Address - Phone:973-673-9229
Practice Address - Fax:973-673-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ6915OtherRAILROAD MEDICARE
NJ6874509Medicaid
CJ6915OtherRAILROAD MEDICARE
051480Medicare ID - Type Unspecified