| Primary Care Providers, Llc | |
|
2640 Hwy 70, Bldg.5 Suite 102b Manasquan NJ 08736 | |
| (732) 292-0100 | |
| (732) 292-0900 |
| Full Name | Primary Care Providers, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2640 Hwy 70, Bldg.5 Suite 102b, Manasquan, New Jersey |
| Authorized Official Name and Position | Corina M Ianculovici (CEO) |
| Authorized Official Contact | 7322920100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Providers, Llc 2640 Highway 70 Building 6b Manasquan NJ 08736-2610 Ph: (732) 292-0100 | Primary Care Providers, Llc 2640 Hwy 70, Bldg.5 Suite 102b Manasquan NJ 08736 Ph: (732) 292-0100 |
| NPI Number | 1871068726 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 11/07/2019 |
| Medicare PECOS PAC ID | 8628314408 |
|---|---|
| Medicare Enrollment ID | O20190116000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871068726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Corina M Ianculovici |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053818559 PECOS PAC ID: 2264778042 Enrollment ID: I20190116000821 |
| Provider Name | Kathryn A Vieira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629540976 PECOS PAC ID: 2567798424 Enrollment ID: I20190730002928 |
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