NPIMap

Organization Active NPI

Ethel and Raphael Pediatrics

  • Pediatrics Physician
  • Ocean, NJ
National Provider Identifier
1124282330
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA07961200 Issued in NJ
Legal business name
ETHEL AND RAPHAEL PEDIATRICS
Practice address
1405 Highway 35
Suite 104
Ocean, NJ 07712-3532
Phone
(732) 531-2200
Fax
(732) 531-2900
NPI assigned
Jul 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Olukemi Omotoso, MDNPI 1871575084
Title
Owner
Phone
(732) 531-2200

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 25MA07961200 NJ Primary

Addresses

Primary practice location

1405 Highway 35
Suite 104
Ocean, NJ 07712-3532

Mailing address

1405 Highway 35
Suite 104
Ocean, NJ 07712-3532
Phone (732) 531-2200

National Provider Directory

National Provider Directory

Locations

1405 Highway 35
Ste 104
Ocean, NJ 07712
Phone (732) 531-2200

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15362/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1124282330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 HIGHWAY 35",
            "address_2": "SUITE 104",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077123532",
            "telephone_number": "732-531-2200",
            "fax_number": "732-531-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 HIGHWAY 35",
            "address_2": "SUITE 104",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077123532",
            "telephone_number": "732-531-2200",
            "fax_number": "732-531-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEL AND RAPHAEL PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-16",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "OMOTOSO",
        "authorized_official_first_name": "OLUKEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-531-2200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07961200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.