NPIMap

Organization Active NPI

Providence Pediatric Medical Daycare, Inc.

  • Medically Fragile Infants and Children Day Care
  • Camden, NJ
National Provider Identifier
1083765010
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X
License
158222 Issued in NJ
Legal business name
PROVIDENCE PEDIATRIC MEDICAL DAYCARE, INC.
Practice address
1000 Atlantic Ave
Camden D, 2ND Floor
Camden, NJ 08104-1132
Phone
(856) 338-0900
Fax
(856) 338-0029
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

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

Authorized official

Name
Ms. Leeanna Roman
Title
President
Phone
(856) 753-7763

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medically Fragile Infants and Children Day Care 261QM3000X 158222 NJ Primary

Addresses

Primary practice location

1000 Atlantic Ave
Camden D, 2ND Floor
Camden, NJ 08104-1132

Mailing address

411 Commerce LN
West Berlin, NJ 08091-9254
Phone (856) 753-7763

National Provider Directory

National Provider Directory
Tax ID family
PPMD West Berlin 1St Floor4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1000 Atlantic Ave
Fl 2
Camden, NJ 08104
Phone (856) 246-3538

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1083765010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COMMERCE LN",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080919254",
            "telephone_number": "856-753-7763",
            "fax_number": "856-753-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ATLANTIC AVE",
            "address_2": "CAMDEN D, 2ND FLOOR",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081041132",
            "telephone_number": "856-338-0900",
            "fax_number": "856-338-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PEDIATRIC MEDICAL DAYCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "LEEANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-753-7763",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "NJ",
            "license": "158222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; 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.