1235613498 NPI number — ALL 4 KIDZ PEDIATRICS

Table of content: (NPI 1235613498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235613498 NPI number — ALL 4 KIDZ PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ALL 4 KIDZ PEDIATRICS
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:
1235613498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7224 BERGENLINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BERGEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07047-5417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-869-4603
Provider Business Mailing Address Fax Number:
201-469-4605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7224 BERGENLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BERGEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07047-5417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-869-4603
Provider Business Practice Location Address Fax Number:
201-469-4605
Provider Enumeration Date:
09/24/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CACERES
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-869-4603

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03539879 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".