MEDICARE: GENERAL HEALTH CLINIC MANAGEMENT

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	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1780734764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL HEALTH CLINIC MANAGEMENT

Provider Business Mailing Address
First Line	:	7511 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-868-0021
Fax Number	:	201-868-0642

Provider Business Practice Location Address
First Line	:	7511 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-868-0021
Fax Number	:	201-868-0642

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	IRIS M JOAQUIN
Credential	:
Telephone Number	:	201-868-0021

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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