Rivendell Pediatric and Adolscent Medicine, PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA04122800 Issued in NJ

Legal business name

RIVENDELL PEDIATRIC AND ADOLSCENT MEDICINE, PC

Practice address

25 Homestead Dr
Ste H
Columbus, NJ 08022-1005

Phone

(609) 424-0340

Fax

(609) 298-7452

NPI assigned

Jun 12, 2006

Organization subpart

No

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

• Kenneth Michael Hirsch, MD

  • Pediatrics Physician
  • Columbus, NJ
  • NPI 1023015880

  Pediatrics

  NPD (past) Authorized official

Locations

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

Authorized official

Name

Dr. Kenneth Michael Hirsch, MDNPI 1023015880

Title

MD/Pres

Phone

(609) 424-0340

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497797864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HOMESTEAD DR",
            "address_2": "STE H",
            "city": "COLUMBUS",
            "state": "NJ",
            "postal_code": "080221005",
            "telephone_number": "609-424-0340",
            "fax_number": "609-298-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HOMESTEAD DR",
            "address_2": "STE H",
            "city": "COLUMBUS",
            "state": "NJ",
            "postal_code": "080221005",
            "telephone_number": "609-424-0340",
            "fax_number": "609-298-7452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVENDELL PEDIATRIC AND ADOLSCENT MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HIRSCH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MD/PRES",
        "authorized_official_telephone_number": "609-424-0340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA04122800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard William Redlus, DVM
• Refuge Chiropractic LLC
• Anthony Joseph Reid, PT, DPT
• Zach M Reid, PT
• Alyssa Rieger
• Rebecca A Rizzo, DPT
• Shirley Ann Roberts, MA, LPC, NCC
• Ronald Christopher Robinson, PT, DPT
• Valerie Iovine Rogers, PT, DPT
• Patricia Rossi, LCSW

• All providers in Columbus, NJ
• 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.