Provider Demographics
NPI:1912041229
Name:RENAL HYPERTENSION ASSOCIATES PA
Entity Type:Organization
Organization Name:RENAL HYPERTENSION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TACLOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-523-0317
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1024
Mailing Address - Country:US
Mailing Address - Phone:973-523-0317
Mailing Address - Fax:973-684-8590
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1024
Practice Address - Country:US
Practice Address - Phone:973-523-0317
Practice Address - Fax:973-684-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02844600261Q00000X, 261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1071331OtherHORIZON NJ HEALTH