Healthcare Provider Details

I. General information

NPI: 1093848939
Provider Name (Legal Business Name): PRIMARY CARE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 US HIGHWAY 9
HOWELL NJ
07731-3319
US

IV. Provider business mailing address

4630 US HIGHWAY 9
HOWELL NJ
07731-3319
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-0320
  • Fax:
Mailing address:
  • Phone: 732-370-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA0378890
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSE G GONZALEZ
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 732-370-0320