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General NPI Number Information
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NPI Number | 1912956905
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICIAN, LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 PROSPECT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4433
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Country | US
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Telephone | 201-689-1939
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Fax | 201-689-1935
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Provider Business Mailing Address
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Address Line | PO BOX 454
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City | GARFIELD
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State | NJ
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Zip | 07026-0454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. FELIX FERNANDO PACHECO
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Credential | M.D.
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Telephone | 551-206-8122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA07566000
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License Number State | NJ
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