Provider Demographics
NPI:1316211915
Name:HACKETTSTOWN PEDIATRICS, LLC
Entity type:Organization
Organization Name:HACKETTSTOWN PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-852-8096
Mailing Address - Street 1:4 DOCTORS PARK
Mailing Address - Street 2:SUITE C
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1716
Mailing Address - Country:US
Mailing Address - Phone:908-852-8096
Mailing Address - Fax:908-852-5012
Practice Address - Street 1:4 DOCTORS PARK
Practice Address - Street 2:SUITE C
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1716
Practice Address - Country:US
Practice Address - Phone:908-852-8096
Practice Address - Fax:908-852-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077881002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060691Medicaid
NJ1326045295OtherTYPE 1 NPI