Organization
WEST PATERSON SPECIALTY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD S IBRAHIM MD (OWNER)
(973) 569-4488
Entity
Organization
Contact information
Practice address
871 MCBRIDE AVE, WOODLAND PARK, NJ 07424-2748
(973) 569-4488
(973) 569-4743
Mailing address
871 MCBRIDE AVE, WOODLAND PARK, NJ 07424-2748
(973) 569-4488
(973) 569-4743
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MA61942
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8472505
—
NJ
05
—
8549401
—
NJ
Enumeration date
05/25/2006
Last updated
03/14/2011
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