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General NPI Number Information
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NPI Number | 1750680393
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Entity Type | Organization
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Legal Business Name | EAST BRUNSWICK PRIMARY CARE, PA
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | F1 BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3337
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Country | US
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Telephone | 732-603-0055
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Fax | 732-603-8228
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Provider Business Mailing Address
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Address Line | 15 TIMBER RD
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City | EDISON
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State | NJ
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Zip | 08820-3204
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Country | US
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Telephone | 732-603-0055
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Fax | 732-603-8228
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Authorized Official
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Title or Position | MD
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Name | DR. DENA Y LI
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Credential |
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Telephone | 732-603-0055
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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 | MA69929
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License Number State | NJ
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