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General NPI Number Information
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NPI Number | 1871068726
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PROVIDERS, LLC
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 2640 HWY 70, BLDG.5 SUITE 102B
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City | MANASQUAN
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State | NJ
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Zip | 08736
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Country | US
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Telephone | 732-292-0100
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Fax | 732-292-0900
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Provider Business Mailing Address
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Address Line | 2640 HIGHWAY 70 BUILDING 6B
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City | MANASQUAN
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State | NJ
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Zip | 08736-2610
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Country | US
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Telephone | 732-292-0100
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Fax | 732-292-0900
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Authorized Official
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Title or Position | CEO
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Name | MISS CORINA M IANCULOVICI
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Credential | NP
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Telephone | 732-292-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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