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General NPI Number Information
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NPI Number | 1306312095
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Entity Type | Organization
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Legal Business Name | PRIME ENDOCRINOLOGY, LLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 103 PARKER RD STE B
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1009
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Country | US
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Telephone | 732-222-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PARKER RD STE B
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1009
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Country | US
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Telephone | 732-222-0307
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | SUDHA GANNE
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Credential | MD
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Telephone | 732-222-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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