Provider Demographics
NPI:1730242181
Name:NORTH JERSEY PEDIATRICS
Entity type:Organization
Organization Name:NORTH JERSEY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-703-5590
Mailing Address - Street 1:17-10 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2324
Mailing Address - Country:US
Mailing Address - Phone:201-703-5590
Mailing Address - Fax:201-703-5533
Practice Address - Street 1:17-10 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2324
Practice Address - Country:US
Practice Address - Phone:201-703-5590
Practice Address - Fax:201-703-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty