=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952689879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2011
-----------------------------------------------------
Last Update Date | 07/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 POCONO RD SUITE 313
-----------------------------------------------------
City | DENVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07834-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-625-0112
-----------------------------------------------------
Fax | 973-625-0721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 SOUTH ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-971-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID SHULKIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-971-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------