Basic Information
Provider Information
NPI: 1669802039
EntityType: 2
ReplacementNPI:  
OrganizationName: PRIMARY CARE PARTNERS, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NERMI ONAT, MD-PRIMARY CARE PARTNERS AFFILIATE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2403
Address2:  
City: VOORHEES
State: NJ
PostalCode: 080436403
CountryCode: US
TelephoneNumber: 8567823300
FaxNumber: 8565048206
Practice Location
Address1: 239 LAKEVIEW AVE
Address2:  
City: CLIFTON
State: NJ
PostalCode: 070114011
CountryCode: US
TelephoneNumber: 9732539666
FaxNumber: 9732530088
Other Information
ProviderEnumerationDate: 11/20/2013
LastUpdateDate: 11/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SHULKIN
AuthorizedOfficialFirstName: DAVID
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 8567823300
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: PRIMARY CARE PARTNERS, LLC
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2300X  Y Ambulatory Health Care FacilitiesClinic/CenterPrimary Care

No ID Information.


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