Healthcare Provider Details

I. General information

NPI: 1407723034
Provider Name (Legal Business Name): SUBURBAN HEALTH CLINIC OF PATERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 BROADWAY STE 1V2
PATERSON NJ
07514-1524
US

IV. Provider business mailing address

680 BROADWAY STE 1V2
PATERSON NJ
07514-1524
US

V. Phone/Fax

Practice location:
  • Phone: 908-258-8765
  • Fax:
Mailing address:
  • Phone: 908-258-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BRAD R SKOKOWSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: LCADC
Phone: 856-287-1952