# MEDICAL SURGICAL FAMILY PRACTICE OF PATERSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376674572
- **Authorized official:** DR. CARLOS TELLO MD (MEDICAL IRECTOR)
- **Authorized official phone:** (973) 345-7113

## Contact information

- **Practice address:** 998 MADISON AVE, PATERSON, NJ 07501-3737
- **Practice address phone:** (973) 345-7113
- **Practice address fax:** (973) 278-5395
- **Mailing address:** PO BOX 1859, PATERSON, NJ 07509-1859
- **Mailing address phone:** (973) 345-7113
- **Mailing address fax:** (973) 278-5395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 25MA04703100 | NJ | — |
| 2086S0129X | Vascular Surgery Physician | 25MA04703100 | NJ | — |
| 208D00000X | General Practice Physician | 25MA04703100 | NJ | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 01/12/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6688900 | — | NJ |