Elizabeth Pediatric Group, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA04177300 Issued in NJ

Legal business name

ELIZABETH PEDIATRIC GROUP, LLC

Practice address

701 Newark Ave
Suite 212
Elizabeth, NJ 07208-3550

Phone

(908) 354-9500

Fax

(908) 354-9077

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth James Davis, MD

Title

Owner

Phone

(908) 354-9500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104031939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 NEWARK AVE",
            "address_2": "SUITE 212",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083550",
            "telephone_number": "908-354-9500",
            "fax_number": "908-354-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 NEWARK AVE",
            "address_2": "SUITE 212",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083550",
            "telephone_number": "908-354-9500",
            "fax_number": "908-354-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH PEDIATRIC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-354-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA04177300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Foot and Ankle Associates Professional Association
• Elizabeth Medical Associates LLC
• Elizabeth Medical Diagnostic Associates Inc
• Elizabeth Medical Group PA
• Elizabeth Oral and Maxillofacial Surgical Group LLC
• Elizabeth Pharmacy Inc
• Elizabeth Physical Therapy & Elizabeth Foot and Ankle Association
• Elizabeth Primary Care, LLC
• Elizabeth Public Schools
• Elizabeth Radiology Associates, P.a.

• Pediatrics Physician in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.