Organization Name: | PRIMARY CARE MEDICAL PRACTICE, LLC |
NPI Number: | 1912113002 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAMUEL ISSAM MALLOUHI (PRESIDENT) |
Mailing Address: | 1031 Mcbride Ave Suite D 205 Woodland Park |
State: | NJ US |
Postal Code: | 074242559 |
Phone Number: | 9732379055 |
Fax Number: | 9732379053 |
NPI Enumeration Date: | 05/15/2007 |
NPI Last Update Date: | 07/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA061762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |