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General NPI Number Information
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NPI Number | 1508851304
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Entity Type | Organization
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Legal Business Name | PARK PRIMARY CARE ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/18/2005
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 453 AMBOY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2960
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Country | US
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Telephone | 732-636-6612
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Fax | 732-636-8224
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | COLONIA
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State | NJ
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Zip | 07067-0331
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Country | US
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Telephone | 732-636-6612
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Fax | 732-605-5806
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Authorized Official
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Title or Position | M.D./PRESIDENT
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Name | DR. JEFFREY ROSEN
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Credential | M.D.
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Telephone | 732-636-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA046971
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License Number State | NJ
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