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Organization

MEDICAL SURGICAL FAMILY PRACTICE OF PATERSON

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARLOS TELLO MD (MEDICAL IRECTOR)
(973) 345-7113
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6688900
NJ
Enumeration date
03/08/2007
Last updated
01/12/2017
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