NPIMap

Organization Active NPI

Mejia Pediatrics LLC

  • Primary Care Clinic/Center
  • Elizabeth, NJ
National Provider Identifier
1043507270
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
1428465 Issued in NJ
Legal business name
MEJIA PEDIATRICS LLC
Practice address
433 N Broad St
Elizabeth, NJ 07208-3300
Phone
(908) 436-1002
Fax
(908) 436-1109
NPI assigned
Jul 8, 2011
Last updated
Jul 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Authorized official

Name
Johanna J Gonzalez MejiaNPI 1669565396
Title
Owner
Phone
(908) 436-1002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 1428465 NJ Primary

Addresses

Primary practice location

433 N Broad St
Elizabeth, NJ 07208-3300

Mailing address

433 N Broad St
Elizabeth, NJ 07208-3300
Phone (908) 436-1002

Other identifiers 1

IdentifierTypeStateIssuer
0261181MedicaidNJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2064544Mejia Pediatrics LLC433 North Broad Street, Elizabeth, NJ 07208Certificate of waiverAug 20, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1043507270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 N BROAD ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083300",
            "telephone_number": "908-436-1002",
            "fax_number": "908-436-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 N BROAD ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083300",
            "telephone_number": "908-436-1002",
            "fax_number": "908-436-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEJIA PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ MEJIA",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-436-1002"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "1428465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0261181",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.