Organization
PRIMARY CARE PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CORINA M IANCULOVICI NP (CEO)
(732) 292-0100
Entity
Organization
Contact information
Practice address
2640 HWY 70, BLDG.5 SUITE 102B, MANASQUAN, NJ 08736
(732) 292-0100
(732) 292-0900
Mailing address
2640 HIGHWAY 70 BUILDING 6B, MANASQUAN, NJ 08736-2610
(732) 292-0100
(732) 292-0900
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
10/08/2018
Last updated
11/07/2019
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