Provider Demographics
NPI:1124831946
Name:PRIMES PEDIATRIC DEVELOPMENT CENTER
Entity type:Organization
Organization Name:PRIMES PEDIATRIC DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:INBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-310-1023
Mailing Address - Street 1:175 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2340
Mailing Address - Country:US
Mailing Address - Phone:973-310-1023
Mailing Address - Fax:
Practice Address - Street 1:175 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2340
Practice Address - Country:US
Practice Address - Phone:973-310-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech