Organization · NPI-2

100 Main Medical Associates

Internal Medicine · Paterson, NJ

NPI number1619378239
StatusActive
Last updated in NPPESSep 15, 2014

Details

NPI
1619378239
Entity type
Organization (NPI-2)
Legal business name
100 Main Medical Associates
Organization subpart
No
Enumeration date
Sep 15, 2014
Last updated
Sep 15, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes

Practice location

100 Main St
Paterson, NJ 07505-1024

Phone 973-523-0317 · Fax 973-684-8590

Mailing address

100 Main St
Paterson, NJ 07505-1024

Phone 973-523-0317 · Fax 973-684-8590

Authorized official

Lowell Taclob
President
9735230317

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