| Center For Preventative Medicine Of New Jersey | |
|
5 Stanley Rd South Orange NJ 07079-2721 | |
| (973) 762-6077 | |
| Not Available |
| Full Name | Center For Preventative Medicine Of New Jersey |
|---|---|
| Speciality | Internal Medicine |
| Location | 5 Stanley Rd, South Orange, New Jersey |
| Authorized Official Name and Position | Kevin D Holder (OWNER) |
| Authorized Official Contact | 9737626077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Preventative Medicine Of New Jersey 5 Stanley Rd South Orange NJ 07079-2721 Ph: (973) 762-6077 | Center For Preventative Medicine Of New Jersey 5 Stanley Rd South Orange NJ 07079-2721 Ph: (973) 762-6077 |
| NPI Number | 1083747299 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 04/16/2013 |
| Medicare PECOS PAC ID | 7214840602 |
|---|---|
| Medicare Enrollment ID | O20031111000583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083747299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25MA04662500 (New Jersey) | Secondary |
| 207R00000X | Internal Medicine | 25MA04002500 (New Jersey) | Primary |
| Provider Name | Kevin Holder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063543254 PECOS PAC ID: 9436062809 Enrollment ID: I20031111000498 |
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