Mystic Island Pediatric Associates, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

25MA05073700 Issued in NJ

Legal business name

MYSTIC ISLAND PEDIATRIC ASSOCIATES, LLC

Practice address

1387 Route 539 Unit 2C
Little Egg Harbor TWP, NJ 08087-9804

Phone

(609) 296-1900

Fax

(609) 296-1906

NPI assigned

May 18, 2010

Last updated

Sep 4, 2026By 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. Gene Chiu Lee, MDNPI 1558459883

Title

VP

Phone

(609) 294-5500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

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.

• Gene Chiu Lee, M.D.

  • Pediatrics Physician
  • Little Egg Harbor TWP, NJ
  • NPI 1558459883
  Medicare reassignment NPD Authorized official
• Erika Humphreys, M.D.

  • Pediatrics Physician
  • Little Egg Harbor TWP, NJ
  • NPI 1922054931
  NPD (past)

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788480000000",
    "number": "1679892533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1387 ROUTE 539 UNIT 2C",
            "city": "LITTLE EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "080879804",
            "telephone_number": "609-296-1900",
            "fax_number": "609-296-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1387 ROUTE 539 UNIT 2C",
            "city": "LITTLE EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "080879804",
            "telephone_number": "609-296-1900",
            "fax_number": "609-296-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC ISLAND PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-18",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "GENE",
        "authorized_official_middle_name": "CHIU",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "609-294-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "25MA05073700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Little Egg Harbor TWP, NJ
• Providers in Little Egg Harbor TWP, NJ by specialty
• Medical Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.