Organization · NPI-2

21st Avenue Primary Care PA

Family Medicine · Paterson, NJ

NPI number1609163716
StatusActive
Last updated in NPPESJul 9, 2011

Details

NPI
1609163716
Entity type
Organization (NPI-2)
Legal business name
21st Avenue Primary Care PA
Organization subpart
No
Enumeration date
Jul 9, 2011
Last updated
Jul 9, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine25MA05907400NJYes

Practice location

534 21st Ave
Paterson, NJ 07513-1337

Phone 973-925-5400 · Fax 973-925-5403

Mailing address

534 21st Ave
Paterson
Paterson, NJ 07513-1337

Phone 973-925-5400 · Fax 973-925-5403

Authorized official

Hector Jacob Leon-Wong
Owner/Medical Director
9739255400

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Family Medicine providers in Paterson, NJ