Broadway Internal Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA42261 Issued in NJ

Legal business name

BROADWAY INTERNAL MEDICINE PC

Practice address

680 Broadway
5TH Floor Suite # 502
Paterson, NJ 07514-1524

Phone

(973) 278-2877

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Esrel A Avila, M.D.

Title

Medical Direcxtor

Phone

(973) 278-3254

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1992820435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 BROADWAY",
            "address_2": "5TH FLOOR SUITE # 502",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141524",
            "telephone_number": "973-278-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 BROADWAY",
            "address_2": "5TH FLOOR SUITE # 502",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141524",
            "telephone_number": "973-278-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "ESREL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECXTOR",
        "authorized_official_telephone_number": "973-278-3254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA42261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1109502",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.