Sunnyside Pediatrics LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

MA06019 Issued in NJ

Legal business name

SUNNYSIDE PEDIATRICS LLC

Practice address

1182 Stuyvesant Ave
Irvington, NJ 07111-1057

Phone

(973) 399-0571

Fax

(973) 399-1555

NPI assigned

Feb 28, 2012

Last updated

Feb 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justina U Anyanwu, MDNPI 1124034806

Title

Owner

Phone

(973) 399-0571

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/TGXWVOelATtk6ci_q_H9utj9QjU3VuOR/

Practitioners 1

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.

• Justina Anyanwu, MD

  • Pediatrics Physician
  • Irvington, NJ
  • NPI 1124034806
  NPD (past) Authorized official

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

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1114291721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1182 STUYVESANT AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111057",
            "telephone_number": "973-399-0571",
            "fax_number": "973-399-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1182 STUYVESANT AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111057",
            "telephone_number": "973-399-0571",
            "fax_number": "973-399-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "ANYANWU",
        "authorized_official_first_name": "JUSTINA",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-399-0571",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "MA06019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7191308",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Irvington, NJ
• Providers in Irvington, NJ by specialty
• Medical Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; 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.