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General NPI Number Information
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NPI Number | 1912138496
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Entity Type | Organization
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Legal Business Name | PRIME SURGICARE, LLC
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Dates
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Enumeration Date | 08/02/2009
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Last Update Date | 08/02/2009
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Provider Practice Location Address
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Address Line | 901 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 646-642-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLUSEUN SOWEMIMO
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Credential | MD
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Telephone | 646-642-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08584200
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License Number State | NJ
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