Irvington Pediatric Associates, P.a.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

25MA05388700 Issued in NJ

Legal business name

IRVINGTON PEDIATRIC ASSOCIATES, P.A.

Practice address

22 Ball St
Suite 100
Irvington, NJ 07111-3521

Phone

(973) 371-1600

NPI assigned

Jul 11, 2006

Organization subpart

No

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

Authorized official

Name

Bernier Lauredan, MD

Title

Medical Director

Phone

(973) 371-1600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770518698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "address_2": "SUITE 100",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "address_2": "SUITE 100",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRVINGTON PEDIATRIC ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAUREDAN",
        "authorized_official_first_name": "BERNIER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "973-371-1600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "25MA05388700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0677701",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irvington Health Care Providers, LLC
• Irvington Healthcare Providers LLC
• Irvington Healthcare Providers LLC
• Irvington Home Health Care LLC
• Irvington Medical Imaging P.C.
• Irvington Pharmacy LLC
• Irvington Physical Therapy
• Irvington Primary Care LLC
• Callista Ngozi Iwuala, APN-C
• Jennifer Iwudibia, PHARMD

• Preferred Provider Organization in Irvington, NJ
• Providers in Irvington, NJ by specialty
• Preferred Provider Organization in New Jersey

• 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.