Pediatrics & Adolescent Saint Mary Clinic, LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

25MA09372400 Issued in NJ

Legal business name

PEDIATRICS & ADOLESCENT SAINT MARY CLINIC, LLC

Practice address

65 Kearny Ave
Kearny, NJ 07032-2334

Phone

(646) 388-2111

NPI assigned

Jan 8, 2016

Organization subpart

No

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

Authorized official

Name

Inas Wassef, MD

Title

Owner

Phone

(646) 388-2111

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452211200000",
    "number": "1831555705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 GREEN VALLEY RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103121825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 KEARNY AVE",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070322334",
            "telephone_number": "646-388-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS & ADOLESCENT SAINT MARY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-01-08",
        "status": "A",
        "authorized_official_last_name": "WASSEF",
        "authorized_official_first_name": "INAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-388-2111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NJ",
            "license": "25MA09372400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Kearny, NJ
• Providers in Kearny, 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 Jan 8, 2016; 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.