MEDICARE: WAYNE PRIMARY CARE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE PRIMARY CARE, P.A.

Provider Business Mailing Address
First Line	:	508 HAMBURG TPKE
Second Line	:	SUITE102
City	:	WAYNE
State	:	NJ
Zip	:	07470-8482
Country	:	US
Telephone Number	:	973-595-0096
Fax Number	:	973-595-6414

Provider Business Practice Location Address
First Line	:	508 HAMBURG TPKE
Second Line	:	SUITE102
City	:	WAYNE
State	:	NJ
Zip	:	07470-8482
Country	:	US
Telephone Number	:	973-595-0096
Fax Number	:	973-595-6414

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERHAN KUCUK
Credential	:	M.D.
Telephone Number	:	973-595-0096

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/21/2022

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