Organization
BROADWAY INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESREL A AVILA M.D. (MEDICAL DIRECXTOR)
(973) 278-3254
Entity
Organization
Contact information
Practice address
680 BROADWAY, 5TH FLOOR SUITE # 502, PATERSON, NJ 07514-1524
(973) 278-2877
Mailing address
680 BROADWAY, 5TH FLOOR SUITE # 502, PATERSON, NJ 07514-1524
(973) 278-2877
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA42261
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1109502
—
NJ
Enumeration date
03/21/2007
Last updated
04/28/2014
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