Medical Surgical Family Practice of Paterson
Organization Active NPI General Practice Physician · Paterson, NJ
NPI 1376674572 · NPPES record last updated Jan 12, 2017
Key facts
- NPI
- 1376674572
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 25MA04703100 (NJ)
- Legal business name
- MEDICAL SURGICAL FAMILY PRACTICE OF PATERSON
- Practice address
- 998 Madison Ave
Paterson, NJ 07501-3737 - Phone
- (973) 345-7113
- Fax
- (973) 278-5395
- NPI assigned
- Mar 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Carlos Tello, MD
- Title
- Medical Irector
- Phone
- (973) 345-7113
Practitioners 7
-
Carlos A Tello, MD PA
-
Ynes D Accilien, APN
-
Rosa Calderon, M.D.
-
Gladys Miller, APN
-
Rocio A. Oscanoa, ADV. PRACTICE NURSE
-
Agustin A. Colon, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050125000620 | NJ | Part B Supplier - Clinic/Group Practice | 2365492691 |
Receives reassigned benefits from 1 practitioner Practice locations: Paterson, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | 25MA04703100 | NJ | |
| Vascular Surgery Physician |
2086S0129X | 25MA04703100 | NJ | |
| General Practice Physician |
208D00000X | 25MA04703100 | NJ | Yes |
Addresses
Primary practice location
998 Madison Ave
Paterson, NJ 07501-3737
Mailing address
PO Box 1859
Paterson, NJ 07509-1859
Phone (973) 345-7113
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6688900 | Medicaid | NJ |
Other providers in Paterson, NJ
- Aeisha McLeod-Robinson
- Tomicka S McMillion
- Myesha McNeil
- MD Health Group LLC
- Medical Concepts LLC
- Medicon Diagnostic Laboratory LLC
- Medicsurg
- Medina Pharmacy Inc
- Medina Pharmacy Inc
- Kathleen Meehan-Hart
All providers in Paterson, NJ · General Practice Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.