Healthcare Provider Details

I. General information

NPI: 1114705662
Provider Name (Legal Business Name): PATIENT CARE MEDICAL GROUP VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MAIN ST
EDISON NJ
08837-3418
US

IV. Provider business mailing address

26 MAIN ST
EDISON NJ
08837-3418
US

V. Phone/Fax

Practice location:
  • Phone: 609-521-4746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PECORA
Title or Position: OWNER
Credential:
Phone: 609-744-0050