Provider Demographics
NPI:1316993850
Name:PRIME PEDIATRICS PC
Entity type:Organization
Organization Name:PRIME PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-373-9600
Mailing Address - Street 1:90 PARLIN LN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5419
Mailing Address - Country:US
Mailing Address - Phone:973-373-9600
Mailing Address - Fax:
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-373-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06157600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9022805Medicaid