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General NPI Number Information
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NPI Number | 1043689383
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Entity Type | Organization
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Legal Business Name | PA CLINICAL CENTER INC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 75 BLOOMFIELD AVE STE 206
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City | DENVILLE
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State | NJ
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Zip | 07834-2736
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Country | US
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Telephone | 973-960-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 75 BLOOMFIELD AVENUE SUITE 206
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City | DENVILLE
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State | NJ
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Zip | 07834
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Country | US
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Telephone | 973-960-4430
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YOANDI MARRERO
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Credential |
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Telephone | 973-960-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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