| Essex Primary Care Pc | |
|
825 Bloomfield Ave Verona NJ 07044-1366 | |
| (973) 794-1185 | |
| (973) 669-5988 |
| Full Name | Essex Primary Care Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 825 Bloomfield Ave, Verona, New Jersey |
| Authorized Official Name and Position | Mamatha R Gadarla (OWNER) |
| Authorized Official Contact | 9737941185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Essex Primary Care Pc 825 Bloomfield Ave Verona NJ 07044-1366 Ph: (973) 794-1185 | Essex Primary Care Pc 825 Bloomfield Ave Verona NJ 07044-1366 Ph: (973) 794-1185 |
| NPI Number | 1205240025 |
|---|---|
| Provider Enumeration Date | 06/19/2014 |
| Last Update Date | 06/19/2014 |
| Medicare PECOS PAC ID | 1850607995 |
|---|---|
| Medicare Enrollment ID | O20150903001197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205240025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA08121700 (New Jersey) | Primary |
| Provider Name | Mamatha R Gadarla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124167879 PECOS PAC ID: 1052419686 Enrollment ID: I20071112000529 |
| Provider Name | Deval P Gadhvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518119700 PECOS PAC ID: 0345302576 Enrollment ID: I20081223000357 |
| Provider Name | Lovan Vanclin Oloko-nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750926689 PECOS PAC ID: 3577990167 Enrollment ID: I20200220000709 |
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