Pedi Doc, P.a.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

25MA05388700 Issued in NJ

Legal business name

PEDI DOC, P.A.

Practice address

205 Smith St
Suite D
Perth Amboy, NJ 08861-4323

Phone

(732) 697-1600

NPI assigned

Jul 13, 2006

Organization subpart

Yes

Parent organization

ESSEX PEDI DOC, LLCAs reported in NPPES

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

Authorized official

Name

Bernier Lauredan, MD

Title

Medical Director

Phone

(973) 371-1600

Specialties & licenses 1

Addresses

Part of

Essex Pedidoc LLC

Locations

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1073538658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "address_2": "SUITE 100",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SMITH ST",
            "address_2": "SUITE D",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088614323",
            "telephone_number": "732-697-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDI DOC, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSEX PEDI DOC, LLC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "LAUREDAN",
        "authorized_official_first_name": "BERNIER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "973-371-1600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "25MA05388700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.