NPIMap

Organization Active NPI

Lakewood Pediatric Associates

  • Pediatrics Physician
  • Lakewood, NJ
National Provider Identifier
1528015153
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA02835000 Issued in NJ
Legal business name
LAKEWOOD PEDIATRIC ASSOCIATES
Practice address
101 Prospect St
Suite 112
Lakewood, NJ 08701-5020
Phone
(732) 363-1424
Fax
(732) 370-0714
NPI assigned
May 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Suman Jain, M.D.NPI 1114027109
Title
President
Phone
(732) 363-1424

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 Physician 208000000X 25MA02835000 NJ Primary

Addresses

Primary practice location

101 Prospect St
Suite 112
Lakewood, NJ 08701-5020

Mailing address

101 Prospect St
Suite 112
Lakewood, NJ 08701-5020
Phone (732) 363-1424

Other identifiers 1

IdentifierTypeStateIssuer
1299301MedicaidNJ

National Provider Directory

National Provider Directory

Locations

101 Prospect St
Ste 112
Lakewood, NJ 08701
Phone (732) 363-1424

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528015153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PROSPECT ST",
            "address_2": "SUITE 112",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015020",
            "telephone_number": "732-363-1424",
            "fax_number": "732-370-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROSPECT ST",
            "address_2": "SUITE 112",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015020",
            "telephone_number": "732-363-1424",
            "fax_number": "732-370-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "SUMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-363-1424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA02835000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1299301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • 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.