# PROSPECT MEDICAL OFFICE, LLC

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

## Provider details

- **NPI number:** 1609956556
- **Authorized official:** SUSAN TEREK (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (201) 444-4530

## Contact information

- **Practice address:** 301 GODWIN AVE, MIDLAND PARK, NJ 07432-1544
- **Practice address phone:** (201) 444-4526
- **Practice address fax:** (201) 689-0638
- **Mailing address:** 301 GODWIN AVE, MIDLAND PARK, NJ 07432-1544
- **Mailing address phone:** (201) 444-4526
- **Mailing address fax:** (201) 689-0638

## Taxonomy

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

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 12/07/2012