Healthcare Provider Details

I. General information

NPI: 1801194709
Provider Name (Legal Business Name): PNJ PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 BUCKEYSTOWN PIKE STE 186
FREDERICK MD
21704-8337
US

IV. Provider business mailing address

5100 BUCKEYSTOWN PIKE STE 186
FREDERICK MD
21704-8337
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-8888
  • Fax: 301-682-3515
Mailing address:
  • Phone: 301-682-8888
  • Fax: 301-682-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD00286640
License Number StateMD

VIII. Authorized Official

Name: YITZCHOK GOLD
Title or Position: OWNER
Credential:
Phone: 732-684-0885