Provider Demographics
NPI:1053631846
Name:PANDE V. JOSIFOSKI, M.D., L.L.C.
Entity Type:Organization
Organization Name:PANDE V. JOSIFOSKI, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-748-0678
Mailing Address - Street 1:123 HIGHLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1527
Mailing Address - Country:US
Mailing Address - Phone:973-748-0678
Mailing Address - Fax:973-748-2808
Practice Address - Street 1:123 HIGHLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1527
Practice Address - Country:US
Practice Address - Phone:973-748-0678
Practice Address - Fax:973-748-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02629900261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D1696904Medicaid
NJE70427Medicare UPIN
NJ1D1696904Medicaid