Provider Demographics
NPI:1275819823
Name:PATISH DPM PC
Entity Type:Organization
Organization Name:PATISH DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUGOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-424-0080
Mailing Address - Street 1:23 BRANFORD PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2711
Mailing Address - Country:US
Mailing Address - Phone:973-424-0080
Mailing Address - Fax:973-424-0088
Practice Address - Street 1:23 BRANFORD PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2711
Practice Address - Country:US
Practice Address - Phone:973-424-0080
Practice Address - Fax:973-424-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00298800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty