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General NPI Number Information
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NPI Number | 1588687479
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Entity Type | Organization
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Legal Business Name | PRIMARY MEDICAL CARE PROFESSIONAL
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 85 S JEFFERSON ST STE. 3
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City | ORANGE
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State | NJ
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Zip | 07050-1562
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Country | US
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Telephone | 973-673-9229
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Fax | 973-673-0018
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Provider Business Mailing Address
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Address Line | 85 S JEFFERSON ST STE.1
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City | ORANGE
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State | NJ
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Zip | 07050-1562
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Country | US
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Telephone | 973-677-3466
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Fax | 973-677-2362
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH SALESE
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Credential | MD
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Telephone | 973-673-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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