Healthcare Provider Details

I. General information

NPI: 1780518910
Provider Name (Legal Business Name): WIDERCARE COMMUNITY HEALTH OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GEORGE ST STE 320
NEW BRUNSWICK NJ
08901-2091
US

IV. Provider business mailing address

1303 PENDLETON ST SE
ATLANTA GA
30316-3801
US

V. Phone/Fax

Practice location:
  • Phone: 323-776-3632
  • Fax:
Mailing address:
  • Phone: 888-689-4337
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP A MITCHELL
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 720-480-9613