Organization
PRIME HEALTHCARE SERVICES-ST MICHAELS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
(909) 235-4307
Entity
Organization
Contact information
Practice address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 854-3592
(973) 877-2434
Mailing address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 854-3592
(973) 877-2434
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
Other
Enumeration date
05/09/2016
Last updated
05/12/2016
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