MEDICARE: PRIME HEALTH GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497513246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	208 LENOX AVE # 154
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-5120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 LENOX AVE # 154
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-5120
Country	:	US
Telephone Number	:	732-443-1700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUPRIYA HOSADURGA
Credential	:	MD
Telephone Number	:	908-721-2153

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “PRIME HEALTH GROUP LLC ” Practice Location

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