Healthcare Provider Details

I. General information

NPI: 1477855971
Provider Name (Legal Business Name): FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 BROADWAY
PATERSON NJ
07514-2517
US

IV. Provider business mailing address

PO BOX 2042
BLOOMFIELD NJ
07003-2042
US

V. Phone/Fax

Practice location:
  • Phone: 973-278-7500
  • Fax: 973-278-7300
Mailing address:
  • Phone: 973-278-7500
  • Fax: 973-278-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. QUINCY L HAYWOOD JR.
Title or Position: PRESIDENT/ OWNER
Credential: CEO
Phone: 973-207-1147