NPIMap

Organization Active NPI

Iris Pediatrics, LLC

  • Primary Care Clinic/Center
  • Holmdel, NJ
National Provider Identifier
1376903211
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
25MA08017300 Issued in NJ
Legal business name
IRIS PEDIATRICS, LLC
Practice address
702 N Beers St
Suite 1
Holmdel, NJ 07733-1520
Phone
(732) 862-0200
NPI assigned
Mar 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Authorized official

Name
Dr. Yelena Potylitsina, MDNPI 1568592632
Title
Medical Director
Phone
(732) 862-0200

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
Primary Care Clinic/Center 261QP2300X 25MA08017300 NJ Primary

Addresses

Primary practice location

702 N Beers St
Suite 1
Holmdel, NJ 07733-1520

Mailing address

702 N Beers St
Suite 1
Holmdel, NJ 07733-1520
Phone (732) 862-0200

National Provider Directory

National Provider Directory

Locations

702 N Beers St
Ste 1
Holmdel, NJ 07733
Phone (732) 862-0200

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": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1376903211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 N BEERS ST",
            "address_2": "SUITE 1",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331520",
            "telephone_number": "732-862-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N BEERS ST",
            "address_2": "SUITE 1",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331520",
            "telephone_number": "732-862-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRIS PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "POTYLITSINA",
        "authorized_official_first_name": "YELENA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "732-862-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MA08017300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holmdel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.