# PARK AVE MEDICAL CENTRE LLC

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

## Provider details

- **NPI number:** 1447533773
- **Authorized official:** DR. RAFATH K HUMERA MD (SOLE PROPREITER)
- **Authorized official phone:** (862) 239-4808

## Contact information

- **Practice address:** 535 GETTY AVE, SUITE 3, CLIFTON, NJ 07011-2105
- **Practice address phone:** (862) 239-4808
- **Mailing address:** 1367 RATZER RD, WAYNE, NJ 07470-2429
- **Mailing address phone:** (862) 239-4808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA08760600 | NJ | Yes |

## Other

- **Enumeration date:** 09/22/2011
- **Last updated:** 09/22/2011