Pediatric Surgery Group, LLC

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

Legal business name

PEDIATRIC SURGERY GROUP, LLC

Practice address

2130 Millburn Ave
Maplewood, NJ 07040-3725

Phone

(973) 313-3115

Fax

(973) 313-3188

NPI assigned

Aug 2, 2006

Last updated

Dec 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Colin Bethel, M.D.

Title

Managing Member

Phone

(973) 660-9334

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1679580781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25B VREELAND RD",
            "address_2": "SUITE 110",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321900",
            "telephone_number": "973-660-9334",
            "fax_number": "973-660-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 MILLBURN AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403725",
            "telephone_number": "973-313-3115",
            "fax_number": "973-313-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SURGERY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "BETHEL",
        "authorized_official_first_name": "COLIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "973-660-9334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joseph Pfeifer
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• Pediatric Surgery Physician in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Pediatric Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.