Healthcare Provider Details

I. General information

NPI: 1669814141
Provider Name (Legal Business Name): PRIMARY CARE PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 SOUTH AVE
FANWOOD NJ
07023-1373
US

IV. Provider business mailing address

PO BOX 2403
VOORHEES NJ
08043-6403
US

V. Phone/Fax

Practice location:
  • Phone: 908-889-8700
  • Fax: 908-889-7799
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID J SHULKIN
Title or Position: CEO
Credential: MD
Phone: 973-971-7165