NPIMap

Organization Active NPI

Tri Town Medical Center

  • Specialist
  • Prospect Park, NJ
National Provider Identifier
1891865556
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA06054400 Issued in NJ
Legal business name
TRI TOWN MEDICAL CENTER
Practice address
160 Haledon Ave
Prospect Park, NJ 07508-2051
Phone
(973) 942-3200
Fax
(973) 942-2901
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mohamed Kawam, M.D.
Title
Delegated Official
Phone
(973) 942-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 25MA06054400 NJ Primary

Addresses

Primary practice location

160 Haledon Ave
Prospect Park, NJ 07508-2051

Mailing address

PO Box 3400
Wayne, NJ 07474-3400
Phone (973) 942-3200

Other identifiers 1

IdentifierTypeStateIssuer
2626509001OtherNJAMERIHEALTH GROUP #

National Provider Directory

National Provider Directory

Locations

160 Haledon Ave
Prospect Park, NJ 07508
Phone (973) 942-3200

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1891865556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3400",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074743400",
            "telephone_number": "973-942-3200",
            "fax_number": "973-942-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HALEDON AVE",
            "city": "PROSPECT PARK",
            "state": "NJ",
            "postal_code": "075082051",
            "telephone_number": "973-942-3200",
            "fax_number": "973-942-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI TOWN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KAWAM",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "973-942-3200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06054400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP #",
            "identifier": "2626509001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prospect Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.