Provider Demographics
NPI:1912657750
Name:ST JOSEPHS MEDICAL GROUP PC
Entity Type:Organization
Organization Name:ST JOSEPHS MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-754-2892
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1501
Practice Address - Country:US
Practice Address - Phone:973-928-2880
Practice Address - Fax:973-928-2881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPHS MEDICAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care