Provider Demographics
NPI:1154375186
Name:PATERSON COMMUNITY CLINIC, PA
Entity type:Organization
Organization Name:PATERSON COMMUNITY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:AQEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-523-9090
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:973-685-9922
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:973-685-9922
Practice Address - Fax:973-685-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6849709Medicaid
NJ6849709Medicaid
NJ002964Medicare ID - Type Unspecified