Provider Demographics
NPI:1871678433
Name:WEST PATERSON FAMILY MEDICAL CENTER,PA
Entity Type:Organization
Organization Name:WEST PATERSON FAMILY MEDICAL CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-256-7599
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:D109
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-785-4020
Mailing Address - Fax:973-785-3186
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:D109
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-785-4020
Practice Address - Fax:973-785-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3056902Medicaid
NJ3056902Medicaid