Basic Information
| Provider Information | |||||||||
| NPI: | 1598283814 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUNTERDON PRIMARY CARE PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HUNTERDON MEDICAL ASSOCIATES AT WHITEHOUSE STATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 MINNEAKONING RD | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088225726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082841125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 537 US HIGHWAY 22 E FL 3 | ||||||||
| Address2: | |||||||||
| City: | WHITEHOUSE STATION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088893696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085342249 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2017 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERMONTIZ | ||||||||
| AuthorizedOfficialFirstName: | WANDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9082841125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.