Organization Name: | FAMILY MEDICAL SPECIALIST PA |
NPI Number: | 1942523105 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSE LOPEZ (MANAGER) |
Mailing Address: | 534 21st Ave Paterson |
State: | NJ US |
Postal Code: | 075131337 |
Phone Number: | 9736539669 |
Fax Number: | |
NPI Enumeration Date: | 03/02/2010 |
NPI Last Update Date: | 03/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 25MA03169500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |