Primary Care Medical Group Pa | |
450 Bergen St Harrison NJ 07029-2291 | |
(973) 484-6900 | |
(973) 484-0029 |
Full Name | Primary Care Medical Group Pa |
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Speciality | Internal Medicine |
Location | 450 Bergen St, Harrison, New Jersey |
Authorized Official Name and Position | Ralph S D'agostino (OWNER) |
Authorized Official Contact | 9734846900 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Primary Care Medical Group Pa 450 Bergen St Harrison NJ 07029-2291 Ph: (973) 484-6900 | Primary Care Medical Group Pa 450 Bergen St Harrison NJ 07029-2291 Ph: (973) 484-6900 |
NPI Number | 1134386410 |
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Provider Enumeration Date | 05/22/2008 |
Last Update Date | 06/04/2008 |
Medicare PECOS PAC ID | 6305850249 |
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Medicare Enrollment ID | O20060131000554 |
Identifier | Type | State | Issuer |
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1134386410 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | 31348 (New Jersey) | Primary |
Provider Name | Joseph F Ardolino |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1275759516 PECOS PAC ID: 3779532171 Enrollment ID: I20050112000780 |
Provider Name | Paul Fontanazza |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1225041965 PECOS PAC ID: 7113979410 Enrollment ID: I20050215000612 |
Provider Name | Ralph Dagostino |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790798437 PECOS PAC ID: 8628020922 Enrollment ID: I20050215000647 |
Harrison Medical Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 332 Harrison Ave, Harrison, NJ 07029 Phone: 973-484-9216 Fax: 973-484-9216 |