Healthcare Provider Details

I. General information

NPI: 1912041229
Provider Name (Legal Business Name): RENAL HYPERTENSION ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST
PATERSON NJ
07505-1024
US

IV. Provider business mailing address

100 MAIN ST
PATERSON NJ
07505-1024
US

V. Phone/Fax

Practice location:
  • Phone: 973-523-0317
  • Fax: 973-684-8590
Mailing address:
  • Phone: 973-523-0317
  • Fax: 973-684-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA02844600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number25MA02844600
License Number StateNJ

VIII. Authorized Official

Name: DR. LOWELL T TACLOB
Title or Position: DOCTOR
Credential: M.D.
Phone: 973-523-0317