Provider Demographics
NPI:1902971484
Name:TOMS RIVER PRIMARY CARE LLC
Entity type:Organization
Organization Name:TOMS RIVER PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER MEDICAL DIRECTOR TO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GIARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-914-0070
Mailing Address - Street 1:3 PLAZA DRIVE
Mailing Address - Street 2:SUITE 6 TOMS RIVER PRIMARY CARE LLC
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3764
Mailing Address - Country:US
Mailing Address - Phone:732-914-0070
Mailing Address - Fax:732-914-0071
Practice Address - Street 1:3 PLAZA DRIVE
Practice Address - Street 2:SUITE 6 TOMS RIVER PRIMARY CARE LLC
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3764
Practice Address - Country:US
Practice Address - Phone:732-914-0070
Practice Address - Fax:732-914-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05373700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16917Medicare UPIN
NJ710676Medicare ID - Type Unspecified