MEDICARE: GREAT FALLS MEDICAL CARE PC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1568126597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT FALLS MEDICAL CARE PC

Provider Business Mailing Address
First Line	:	289 UNION AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-1930
Country	:	US
Telephone Number	:	718-930-5008
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 UNION AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-1930
Country	:	US
Telephone Number	:	718-930-5008
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED A SIDDIQUE
Credential	:	MD
Telephone Number	:	718-930-5008

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	01/18/2022

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Directions to “GREAT FALLS MEDICAL CARE PC ” Practice Location

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