Healthcare Provider Details

I. General information

NPI: 1609482926
Provider Name (Legal Business Name): HUNTERDON PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 31 STE 105
FLEMINGTON NJ
08822-5812
US

IV. Provider business mailing address

3 MINNEAKONING RD
FLEMINGTON NJ
08822-5726
US

V. Phone/Fax

Practice location:
  • Phone: 908-782-5100
  • Fax:
Mailing address:
  • Phone: 908-284-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: WANDA BERMONTIZ
Title or Position: BILLING MANAGER
Credential:
Phone: 908-284-1125