Healthcare Provider Details

I. General information

NPI: 1174927305
Provider Name (Legal Business Name): PRIMARY CARE PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 US HIGHWAY 46
LEDGEWOOD NJ
07852-9758
US

IV. Provider business mailing address

PO BOX 2403
VOORHEES NJ
08043-6403
US

V. Phone/Fax

Practice location:
  • Phone: 973-347-8500
  • Fax: 973-347-7320
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID J SHULKIN
Title or Position: CEO
Credential: MD
Phone: 856-782-3300