Holmdel Pediatrics, LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

25MA073809 Issued in NJ

Legal business name

HOLMDEL PEDIATRICS, LLC

Practice address

719 N Beers St
Suite 1E
Holmdel, NJ 07733-1522

Phone

(732) 290-1063

Fax

(732) 739-9537

NPI assigned

Jun 10, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Sowmini Kommireddi, M.D.

Title

President

Phone

(732) 290-1063

Specialties & licenses 1

Addresses

Other identifiers 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1760618383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 N BEERS ST",
            "address_2": "SUITE 1E",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331522",
            "telephone_number": "732-290-1063",
            "fax_number": "732-739-9537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 N BEERS ST",
            "address_2": "SUITE 1E",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331522",
            "telephone_number": "732-290-1063",
            "fax_number": "732-739-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLMDEL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "KOMMIREDDI",
        "authorized_official_first_name": "SOWMINI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-290-1063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NJ",
            "license": "25MA073809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1154462604",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9078502",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1518064260",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Holmdel Ophthalmology LLC
• Holmdel Orthodontics LLC
• Holmdel Pharmacy & Deli LLC
• Holmdel Physical Therapy and Sports Medicine LLC
• Holmdel Pulmonary Medicine, LLC
• Holmdel Sports and Spine
• Holmdel Township Public Schools

• Pediatric Adolescent Medicine Physician in Holmdel, NJ
• Providers in Holmdel, NJ by specialty
• Pediatric Adolescent Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.