Provider Demographics
NPI:1871745711
Name:PRIMECURE, PA
Entity type:Organization
Organization Name:PRIMECURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-5502
Mailing Address - Street 1:445 WHITE HORSE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1408
Mailing Address - Country:US
Mailing Address - Phone:609-581-5502
Mailing Address - Fax:609-581-5504
Practice Address - Street 1:445 WHITE HORSE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1408
Practice Address - Country:US
Practice Address - Phone:609-581-5502
Practice Address - Fax:609-581-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06962600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8478104Medicaid
NJ036268Medicare PIN