Healthcare Provider Details

I. General information

NPI: 1679940779
Provider Name (Legal Business Name): PATIENT FIRST NEW JERSEY PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 CROSS KEYS RD
SICKLERVILLE NJ
08081-9513
US

IV. Provider business mailing address

5000 COX RD 100
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 856-237-1016
  • Fax: 856-237-1017
Mailing address:
  • Phone: 804-822-4383
  • Fax: 804-965-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number25MB09589000
License Number StateNJ

VIII. Authorized Official

Name: ELWOOD PITTS JR.
Title or Position: PHARMACY MANAGER
Credential:
Phone: 804-822-4588