Provider Demographics
NPI:1447653118
Name:PATERSON COMMUNITY CLINIC P.A.
Entity type:Organization
Organization Name:PATERSON COMMUNITY CLINIC P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:BADER
Authorized Official - Last Name:AQEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-670-9102
Mailing Address - Street 1:37 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-1401
Mailing Address - Country:US
Mailing Address - Phone:862-257-1761
Mailing Address - Fax:973-685-9920
Practice Address - Street 1:37 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-1401
Practice Address - Country:US
Practice Address - Phone:862-257-1761
Practice Address - Fax:973-685-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00032051291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory