Provider Demographics
NPI:1124057203
Name:DP PEDIATRICS LLC
Entity type:Organization
Organization Name:DP PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-904-1000
Mailing Address - Street 1:142 TOTOWA RD
Mailing Address - Street 2:#8
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2745
Mailing Address - Country:US
Mailing Address - Phone:973-904-1000
Mailing Address - Fax:973-904-1480
Practice Address - Street 1:142 TOTOWA RD
Practice Address - Street 2:#8
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2745
Practice Address - Country:US
Practice Address - Phone:973-904-1000
Practice Address - Fax:973-904-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA 034566002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9027602Medicaid
NJC55176Medicare UPIN