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NPI Code Detail

MEDICARE: FAMILY MEDICAL SPECIALIST PA

MEDICARE: FAMILY MEDICAL SPECIALIST PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician25MA03169500NJ

General Provider Information

NPI Number : 1942523105
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MEDICAL SPECIALIST PA
Provider Business Mailing Address
First Line : 534 21ST AVE
Second Line :
City : PATERSON
State : NJ
Zip : 07513-1337
Country : US
Telephone Number : 973-653-9669
Fax Number :
Provider Business Practice Location Address
First Line : 534 21ST AVE
Second Line :
City : PATERSON
State : NJ
Zip : 07513-1337
Country : US
Telephone Number : 973-653-9669
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. JOSE LOPEZ
Credential :
Telephone Number : 973-653-9669
Provider Enumeration Date : 03/02/2010
Last Update Date : 03/02/2010

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Directions to “FAMILY MEDICAL SPECIALIST PA ” Practice Location

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