# PRIMARY CARE PROVIDERS, LLC

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

## Provider details

- **NPI number:** 1871068726
- **Authorized official:** MISS CORINA M IANCULOVICI NP (CEO)
- **Authorized official phone:** (732) 292-0100

## Contact information

- **Practice address:** 2640 HWY 70, BLDG.5 SUITE 102B, MANASQUAN, NJ 08736
- **Practice address phone:** (732) 292-0100
- **Practice address fax:** (732) 292-0900
- **Mailing address:** 2640 HIGHWAY 70 BUILDING 6B, MANASQUAN, NJ 08736-2610
- **Mailing address phone:** (732) 292-0100
- **Mailing address fax:** (732) 292-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/08/2018
- **Last updated:** 11/07/2019