Kidzdoc MD Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MAO7567100 Issued in NJ

Legal business name

KIDZDOC MD PEDIATRICS LLC

Doing business as

Pediatrics on Prospect

Practice address

120 Prospect St
South Orange, NJ 07079-2103

Phone

(973) 732-1718

Fax

(973) 732-1719

NPI assigned

Aug 25, 2017

Last updated

Aug 25, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

KIDZDOC MD PEDIATRICS LLCAs reported in NPPES

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

Authorized official

Name

Dr. Judith Colleen Hugh-Goffe, MD

Title

Pediatrician

Phone

(973) 732-1718

Specialties & licenses 1

Addresses

Other names 1

• PEDIATRICS ON PROSPECT Doing business as

Part of

Kidzdoc MD Pediatrics LLC

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1437676848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PROSPECT ST",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792103",
            "telephone_number": "973-732-1718",
            "fax_number": "973-732-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PROSPECT ST",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792103",
            "telephone_number": "973-732-1718",
            "fax_number": "973-732-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZDOC MD PEDIATRICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDZDOC MD PEDIATRICS LLC",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "HUGH-GOFFE",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "COLLEEN",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "973-732-1718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MAO7567100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIATRICS ON PROSPECT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kellianne Josephsen, DPT
• Jeffrey Neil Kaplan, D.P.M.
• Arlene Kappraff, LCSW
• Toby Breitstein Kaufman, PH.D.
• Kids Docs,PC
• Lisa Killian
• Kinetic Studio, LLC
• Shyla Imani Kissoon, PA-C
• Kka Ventures LLC (Homewatch Caregivers of South Orange)
• Katherine Kong, PHARM.D.

• Pediatrics Physician in South Orange, NJ
• Providers in South Orange, 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 25, 2017; 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.