Provider Demographics
NPI:1073779658
Name:CENTER FOR ADULT MEDICINE AND PREVENTIVE CARE, PC
Entity Type:Organization
Organization Name:CENTER FOR ADULT MEDICINE AND PREVENTIVE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-704-8983
Mailing Address - Street 1:916-922 MAIN AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-8544
Mailing Address - Country:US
Mailing Address - Phone:973-773-0334
Mailing Address - Fax:973-773-0336
Practice Address - Street 1:916-922 MAIN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8544
Practice Address - Country:US
Practice Address - Phone:973-773-0334
Practice Address - Fax:973-773-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135720OtherMEDICARE PTAN
NJ134252ZC79Medicare PIN