| Sixty Seven Broadway Medical | |
|
67 Broadway Elmwood Park NJ 07407-1836 | |
| (201) 796-4444 | |
| (201) 796-4034 |
| Full Name | Sixty Seven Broadway Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 67 Broadway, Elmwood Park, New Jersey |
| Authorized Official Name and Position | Cynthia Desane (OFFICE MANAGER) |
| Authorized Official Contact | 2017964444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sixty Seven Broadway Medical 67 Broadway Elmwood Park NJ 07407-1836 Ph: (201) 796-4444 | Sixty Seven Broadway Medical 67 Broadway Elmwood Park NJ 07407-1836 Ph: (201) 796-4444 |
| NPI Number | 1619188414 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619188414 | NPI | - | NPPES |
| 7062206 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MB018796 (New Jersey) | Primary |
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