Provider Demographics
NPI:1053548586
Name:PRIMARY HEALTHCARE LLC
Entity type:Organization
Organization Name:PRIMARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-220-0049
Mailing Address - Street 1:2090 ROUTE 27
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1141
Mailing Address - Country:US
Mailing Address - Phone:732-220-0049
Mailing Address - Fax:732-354-0486
Practice Address - Street 1:2090 ROUTE 27
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1141
Practice Address - Country:US
Practice Address - Phone:732-220-0049
Practice Address - Fax:732-354-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0177075Medicaid
NJ148672Medicare UPIN
NJ0177075Medicaid