Organization Name: | AM/PM PRIMARY CARE |
NPI Number: | 1083045694 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WESLEY THEK (DIRECT OWNER) |
Mailing Address: | 19 S Washington Ave Bergenfield |
State: | NJ US |
Postal Code: | 076212324 |
Phone Number: | 2013870177 |
Fax Number: | 2019660588 |
NPI Enumeration Date: | 12/06/2013 |
NPI Last Update Date: | 12/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 25MA06949100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |