Healthcare Provider Details

I. General information

NPI: 1265266530
Provider Name (Legal Business Name): PRIME ARTHRITIS AND RHEUMATOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 BLOOMFIELD AVE STE 203
CALDWELL NJ
07006-5525
US

IV. Provider business mailing address

526 BLOOMFIELD AVE STE 203
CALDWELL NJ
07006-5525
US

V. Phone/Fax

Practice location:
  • Phone: 973-547-3514
  • Fax: 973-228-2104
Mailing address:
  • Phone: 973-547-3514
  • Fax: 973-228-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOWYAD KHALID
Title or Position: OWNER
Credential:
Phone: 973-547-3514