Provider Demographics
NPI:1164018610
Name:PATHFINDER HERITAGE GROUP INC
Entity type:Organization
Organization Name:PATHFINDER HERITAGE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABODAWAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-580-5537
Mailing Address - Street 1:97 LIBERTY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:760-580-5537
Mailing Address - Fax:973-500-3579
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-433-5398
Practice Address - Fax:973-500-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0868426Medicaid