Basic Information
| Provider Information | |||||||||
| NPI: | 1801972484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE ASSOCIATES OF MERCER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SELIM U SHEIKH MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2312 WHITEHORSE MERCERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095866244 | ||||||||
| FaxNumber: | 6095866221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2312 WHITEHORSE MERCERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095866244 | ||||||||
| FaxNumber: | 6095866221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHEIKH | ||||||||
| AuthorizedOfficialFirstName: | SELIM | ||||||||
| AuthorizedOfficialMiddleName: | U | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6095866244 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA006108000 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6749704 | 05 | NJ | MEDICAID |