Provider Demographics
NPI:1306808373
Name:PATERSON DIVISION OF HEALTH
Entity type:Organization
Organization Name:PATERSON DIVISION OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUROWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-321-1277
Mailing Address - Street 1:176 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1115
Mailing Address - Country:US
Mailing Address - Phone:973-321-1277
Mailing Address - Fax:973-321-1246
Practice Address - Street 1:176 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1115
Practice Address - Country:US
Practice Address - Phone:973-321-1277
Practice Address - Fax:973-321-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTAX EXEMPT261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056707Medicaid
NJ984.9Medicaid
NJ3467210Medicaid
NJ520395Medicare ID - Type UnspecifiedPODIATRY CLINIC
NJ762780Medicare ID - Type UnspecifiedFLU AND PNEUMONIA CLINIC