# PRIME HEALTHCARE SERVICES-ST MICHAELS MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326494378
- **Authorized official:** CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
- **Authorized official phone:** (909) 235-4307

## Contact information

- **Practice address:** 111 CENTRAL AVE, NEWARK, NJ 07102-1909
- **Practice address phone:** (973) 854-3592
- **Practice address fax:** (973) 877-2434
- **Mailing address:** 111 CENTRAL AVE, NEWARK, NJ 07102-1909
- **Mailing address phone:** (973) 854-3592
- **Mailing address fax:** (973) 877-2434

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |

## Other

- **Enumeration date:** 05/09/2016
- **Last updated:** 05/12/2016