Organization
PRIMARY CARE MEDICAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL ISSAM MALLOUHI M.D (PRESIDENT)
(973) 237-9055
Entity
Organization
Contact information
Practice address
1031 MCBRIDE AVE, SUITE D 205, WOODLAND PARK, NJ 07424-2559
(973) 237-9055
(973) 237-9053
Mailing address
1031 MCBRIDE AVE, SUITE D 205, WOODLAND PARK, NJ 07424-2559
(973) 237-9055
(973) 237-9053
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA061762
NJ
Other
Enumeration date
05/15/2007
Last updated
07/01/2013
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