Healthcare Provider Details

I. General information

NPI: 1417875659
Provider Name (Legal Business Name): PRIME GERICARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HOPKINS RD
MICKLETON NJ
08056-1273
US

IV. Provider business mailing address

PO BOX 69
MICKLETON NJ
08056-0069
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-8060
  • Fax: 856-848-8038
Mailing address:
  • Phone: 856-848-8060
  • Fax: 856-848-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IMRAN MIRZA
Title or Position: OWNER
Credential: MD
Phone: 856-381-9598