NPIMap

Organization Active NPI

Essex Pedi Docs LLC

  • Pediatrics Physician
  • Irvington, NJ
National Provider Identifier
1518258359
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MA53887 Issued in NJ
Legal business name
ESSEX PEDI DOCS LLC
Practice address
22 Ball St
Irvington, NJ 07111-3521
Phone
(973) 371-1600
Fax
(973) 372-7677
NPI assigned
Apr 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

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

Authorized official

Name
Dr. Bernier Lauredan, M.D.
Title
Owner
Phone
(973) 371-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X MA53887 NJ Primary

Addresses

Primary practice location

22 Ball St
Irvington, NJ 07111-3521

Mailing address

22 Ball St
Irvington, NJ 07111-3521
Phone (973) 371-1600

Other identifiers 1

IdentifierTypeStateIssuer
0677701MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Essex Pedidoc LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

22 Ball St
Irvington, NJ 07111
Phone (973) 371-1600

NPI Registry JSON

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

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1518258359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600",
            "fax_number": "973-372-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600",
            "fax_number": "973-372-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSEX PEDI DOCS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-27",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "LAUREDAN",
        "authorized_official_first_name": "BERNIER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-371-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA53887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0677701",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvington, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; 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.