| Primary Care Group LLC | |
|
2 Westfield Ave Clark NJ 07066-3226 | |
| (908) 505-5141 | |
| Not Available |
| Full Name | Primary Care Group LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Westfield Ave, Clark, New Jersey |
| Authorized Official Name and Position | Domenica Fantini (PHYSICIAN) |
| Authorized Official Contact | 9085055141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Group LLC 2 Westfield Ave Clark NJ 07066-3226 | Primary Care Group LLC 2 Westfield Ave Clark NJ 07066-3226 Ph: (908) 505-5141 |
| NPI Number | 1609421841 |
|---|---|
| Provider Enumeration Date | 08/05/2019 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 8628309382 |
|---|---|
| Medicare Enrollment ID | O20191010000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609421841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Susan a Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649330135 PECOS PAC ID: 6608924873 Enrollment ID: I20090427000366 |
| Provider Name | Domenica Alexandra Fantini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548609464 PECOS PAC ID: 1153629738 Enrollment ID: I20160414001731 |
| Provider Name | Kinjalben Mounesh Shukla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306643242 PECOS PAC ID: 9739673625 Enrollment ID: I20251209001439 |
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