NPIMap

Organization Active NPI

Pediatric Health, PA

  • Pediatrics Physician
  • Freehold, NJ
National Provider Identifier
1043314453
Registry record updated Feb 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC HEALTH, PA
Practice address
470 Stillwells Corner Rd
Freehold, NJ 07728-2969
Phone
(732) 780-3333
Fax
(732) 780-6968
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lopez Roberta
Title
Comptroller
Phone
(732) 780-3333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

470 Stillwells Corner Rd
Freehold, NJ 07728-2969

Mailing address

69 W Main St
Freehold, NJ 07728-2114
Phone (732) 409-3633

Other identifiers 1

IdentifierTypeStateIssuer
3196305MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Health PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1043314453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 W MAIN ST",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282114",
            "telephone_number": "732-409-3633",
            "fax_number": "732-409-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 STILLWELLS CORNER RD",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282969",
            "telephone_number": "732-780-3333",
            "fax_number": "732-780-6968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "ROBERTA",
        "authorized_official_first_name": "LOPEZ",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "732-780-3333"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3196305",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.