Healthcare Provider Details

I. General information

NPI: 1447252291
Provider Name (Legal Business Name): PRIME CARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-18 RIDGE RD
NORTH ARLINGTON NJ
07031-6314
US

IV. Provider business mailing address

16-18 RIDGE RD
NORTH ARLINGTON NJ
07031-6314
US

V. Phone/Fax

Practice location:
  • Phone: 201-997-1010
  • Fax: 201-997-7436
Mailing address:
  • Phone: 201-997-1010
  • Fax: 201-997-7436

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: ERIC M JACKSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-997-1010