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General NPI Number Information
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NPI Number | 1588014922
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Entity Type | Organization
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Legal Business Name | PRIME HEALTH SERVICES
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 393 NORTHFIELD AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3001
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Country | US
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Telephone | 908-721-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 393 NORTHFIELD AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3001
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Country | US
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Telephone | 908-721-2153
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUPRIYA HOSADURGA
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Credential | MD
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Telephone | 908-721-2153
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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 |
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License Number State |
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