1225088917 NPI number — QUALITY CARE PEDIATRICS, LLC.

Table of content: DALE PUSHEE MA (NPI 1134917701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225088917 NPI number — QUALITY CARE PEDIATRICS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY CARE PEDIATRICS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225088917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08002-0505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-755-1616
Provider Business Mailing Address Fax Number:
856-755-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 ZION RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08225-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-641-7008
Provider Business Practice Location Address Fax Number:
609-641-7028
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOLINA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-641-7008

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2150788001 . This is a "AMERIHEALTH HMO/PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 149849 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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