Organization
PRIME HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPRIYA HOSADURGA MD (OWNER)
(908) 721-2153
Entity
Organization
Contact information
Practice address
393 NORTHFIELD AVE, WEST ORANGE, NJ 07052-3001
(908) 721-2153
Mailing address
393 NORTHFIELD AVE, WEST ORANGE, NJ 07052-3001
(908) 721-2153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08162900
MEDICAL LICENSE
NJ
Enumeration date
06/16/2016
Last updated
06/16/2016
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