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General NPI Number Information
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NPI Number | 1447653118
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Entity Type | Organization
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Legal Business Name | PATERSON COMMUNITY CLINIC P.A.
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 37 CROOKS AVE
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City | PATERSON
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State | NJ
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Zip | 07503-1401
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Country | US
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Telephone | 862-257-1761
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Fax | 973-685-9920
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Provider Business Mailing Address
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Address Line | 37 CROOKS AVE
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City | PATERSON
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State | NJ
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Zip | 07503-1401
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Country | US
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Telephone | 862-257-1761
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Fax | 973-685-9920
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHMOUD BADER AQEL
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Credential | MD
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Telephone | 973-670-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 00032051
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License Number State | NJ
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