Provider Demographics
NPI:1962278440
Name:PRIMA PRIMARY CARE AND WELLNESS LLC
Entity type:Organization
Organization Name:PRIMA PRIMARY CARE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-819-1203
Mailing Address - Street 1:501 KINGS HWY E STE 106
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4871
Mailing Address - Country:US
Mailing Address - Phone:203-819-1203
Mailing Address - Fax:
Practice Address - Street 1:501 KINGS HWY E STE 106
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4871
Practice Address - Country:US
Practice Address - Phone:203-819-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty