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NPI Code Detail

MEDICARE: PASSAIC MEDICAL CLINIC INC

MEDICARE: PASSAIC MEDICAL CLINIC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125MA07945900OTHERNJSTATE LICENSE

General Provider Information

NPI Number : 1073108346
Entity Type Code : Organization
Provider Name (Legal Business Name) : PASSAIC MEDICAL CLINIC INC
Provider Business Mailing Address
First Line : 362 MONROE ST
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-4114
Country : US
Telephone Number : 973-777-3222
Fax Number : 973-777-3225
Provider Business Practice Location Address
First Line : 362 MONROE ST
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-4114
Country : US
Telephone Number : 973-777-3222
Fax Number : 973-777-3225
Authorized Official
Title or Position : OWNER
Name : NAEL ABUTABIKH
Credential : MD
Telephone Number : 973-777-3222
Provider Enumeration Date : 03/08/2021
Last Update Date : 03/08/2021

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Directions to “PASSAIC MEDICAL CLINIC INC ” Practice Location

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