New Jersey Pediatric and Adolescent Care, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

25MA06235800 Issued in NJ

Legal business name

NEW JERSEY PEDIATRIC AND ADOLESCENT CARE, LLC

Practice address

1680 Route 23
Suite 350
Wayne, NJ 07470-7501

Phone

(973) 521-9700

NPI assigned

Sep 29, 2013

Last updated

Sep 29, 2013By 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

Lydia M Charles, MDNPI 1598754509

Title

Owner

Phone

(973) 276-1140

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Lydia Charles, MD

  • Pediatric Adolescent Medicine Physician
  • Wayne, NJ
  • NPI 1598754509
  NPD (past) Authorized official
• Alexandra Charles, MD

  • Pediatrics Physician
  • Wayne, NJ
  • NPI 1093205031
  NPD (past)
• Svetlana Gladoun, D.O.

  • Pediatrics Physician
  • Wayne, NJ
  • NPI 1386831337
  NPD (past)
• Katherine Ourfalian, MD

  • Pediatrics Physician
  • Wayne, NJ
  • NPI 1164954491
  NPD (past)
• Persis Thomas, MD

  • Pediatrics Physician
  • West Hartford, CT
  • NPI 1316359045
  NPD (past)
• Katherine Richardson Weinand, CPNP

  • Pediatric Nurse Practitioner
  • Framingham, MA
  • NPI 1114464120
  NPD (past)

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

{
    "created_epoch": "1380412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380412800000",
    "number": "1912334434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 FOX HOLLOW RD",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070459300",
            "telephone_number": "973-276-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 ROUTE 23",
            "address_2": "SUITE 350",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707501",
            "telephone_number": "973-521-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY PEDIATRIC AND ADOLESCENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-29",
        "last_updated": "2013-09-29",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-276-1140",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MA06235800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2013; 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.