Organization
MEDICAL & SURGICAL FAMILY PRACTICE OF PASSAIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS TELLO M.D. (MEDICAL DIRECTOR)
(973) 777-3006
Entity
Organization
Contact information
Practice address
121 PROSPECT ST, PASSAIC, NJ 07055-4926
(973) 777-3006
(973) 777-5587
Mailing address
PO BOX 2007, PATERSON, NJ 07509-2007
(973) 777-3006
(973) 777-5587
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
—
6688608
—
NJ
Enumeration date
03/08/2007
Last updated
03/06/2017
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