Provider Demographics
NPI:1366456105
Name:TOTOWA PEDIATRIC GROUP, P.A.
Entity Type:Organization
Organization Name:TOTOWA PEDIATRIC GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULMASIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-595-0600
Mailing Address - Street 1:290 UNION BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2610
Mailing Address - Country:US
Mailing Address - Phone:973-595-0600
Mailing Address - Fax:
Practice Address - Street 1:290 UNION BLVD
Practice Address - Street 2:STE 2
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2610
Practice Address - Country:US
Practice Address - Phone:973-595-0600
Practice Address - Fax:973-595-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6888305Medicaid