Provider Demographics
NPI:1669663415
Name:PATERSON COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PATERSON COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-790-6594
Mailing Address - Street 1:32 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1775
Mailing Address - Country:US
Mailing Address - Phone:973-790-6594
Mailing Address - Fax:973-790-7703
Practice Address - Street 1:227 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2002
Practice Address - Country:US
Practice Address - Phone:973-278-2600
Practice Address - Fax:973-278-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ82304261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0044342Medicaid
NJ311830Medicare Oscar/Certification