Provider Demographics
NPI:1184811390
Name:PASSAIC MEDICAL CARE INC
Entity type:Organization
Organization Name:PASSAIC MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUTABIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-3222
Mailing Address - Street 1:362 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055
Mailing Address - Country:US
Mailing Address - Phone:973-777-3222
Mailing Address - Fax:
Practice Address - Street 1:166 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5442
Practice Address - Country:US
Practice Address - Phone:973-777-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBA9378161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079049Medicaid
NJ099306Medicare PIN
NJI43508Medicare UPIN