Provider Demographics
NPI:1972776557
Name:PRIMACARE MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:PRIMACARE MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:NYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-409-6400
Mailing Address - Street 1:1610 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6289
Mailing Address - Country:US
Mailing Address - Phone:718-409-6400
Mailing Address - Fax:718-823-9119
Practice Address - Street 1:1610 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6289
Practice Address - Country:US
Practice Address - Phone:718-409-6400
Practice Address - Fax:718-823-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty