# K PRIMARY CARE AND MEDICAL NUTRITION CENTER

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

## Provider details

- **NPI number:** 1477948362
- **Authorized official:** MAUREEN DOHERTY (CREDENTIALING CONTACT)
- **Authorized official phone:** (908) 206-4676

## Contact information

- **Practice address:** 571 CENTRAL AVE, SUITE 104, NEW PROVIDENCE, NJ 07974-1547
- **Practice address phone:** (908) 206-4676
- **Mailing address:** 571 CENTRAL AVE, SUITE 104, NEW PROVIDENCE, NJ 07974-1547
- **Mailing address phone:** (908) 206-4676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NJ | Yes |

## Other

- **Enumeration date:** 03/30/2015
- **Last updated:** 09/01/2015