MEDICARE: GARDEN STATE PRIMARY CARE, PA

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	:	1629135272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN STATE PRIMARY CARE, PA

Provider Business Mailing Address
First Line	:	711 KEARNY AVE
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-3003
Country	:	US
Telephone Number	:	973-868-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 KEARNY AVE
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-3003
Country	:	US
Telephone Number	:	973-868-1494
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MUDASSAR SHARIF
Credential	:	M.D.
Telephone Number	:	973-868-1494

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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