Provider Demographics
NPI:1417048471
Name:PASSAIC COUNTY
Entity Type:Organization
Organization Name:PASSAIC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-278-8818
Mailing Address - Street 1:606 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1916
Mailing Address - Country:US
Mailing Address - Phone:973-248-8818
Mailing Address - Fax:
Practice Address - Street 1:606 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1916
Practice Address - Country:US
Practice Address - Phone:973-248-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03887500207R00000X
NJ25MA06761000207R00000X
NJ25MA04523300207R00000X
NJ25MA03585900207RC0000X, 207RP1001X
NJ25MA074050002085R0202X
NJ25MA026369002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6846505Medicaid
NJ6846505Medicaid
NJC56624Medicare UPIN
NJ043361Medicare ID - Type UnspecifiedMEDICARE GROUP