NPIMap

Organization Active NPI

21St Avenue Primary Care PA

  • Family Medicine Physician
  • Paterson, NJ
National Provider Identifier
1609163716
Registry record updated Jul 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA05907400 Issued in NJ
Legal business name
21ST AVENUE PRIMARY CARE PA
Practice address
534 21St Ave
Paterson, NJ 07513-1337
Phone
(973) 925-5400
Fax
(973) 925-5403
NPI assigned
Jul 9, 2011
Last updated
Jul 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hector Jacob Leon-Wong, MD
Title
Owner/Medical Director
Phone
(973) 925-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA05907400 NJ Primary

Addresses

Primary practice location

534 21St Ave
Paterson, NJ 07513-1337

Mailing address

534 21St Ave
Paterson
Paterson, NJ 07513-1337
Phone (973) 925-5400

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310169600000",
    "number": "1609163716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 21ST AVE",
            "address_2": "PATERSON",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075131337",
            "telephone_number": "973-925-5400",
            "fax_number": "973-925-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 21ST AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075131337",
            "telephone_number": "973-925-5400",
            "fax_number": "973-925-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST AVENUE PRIMARY CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-09",
        "last_updated": "2011-07-09",
        "status": "A",
        "authorized_official_last_name": "LEON-WONG",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "973-925-5400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA05907400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.