Basic Information
Provider Information | |||||||||
NPI: | 1710428289 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HUNTERDON PRIMARY CARE, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HUNTERDON FAMILY PRACTICE & OBSTETRICS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3 MINNEAKONING RD | ||||||||
Address2: |   | ||||||||
City: | FLEMINGTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 088225726 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9082841125 | ||||||||
FaxNumber: | 9082842016 | ||||||||
Practice Location | |||||||||
Address1: | 1100 WESCOTT DR | ||||||||
Address2: | SUITE 101 | ||||||||
City: | FLEMINGTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 088224600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9087886535 | ||||||||
FaxNumber: | 9087886536 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2017 | ||||||||
LastUpdateDate: | 03/16/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SKILLINGE | ||||||||
AuthorizedOfficialFirstName: | DAVID | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT, MEDICAL PRACTICES | ||||||||
AuthorizedOfficialTelephone: | 9087886160 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | D.O, | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.