1821105404 NPI number — KUSER PEDIATRICS LLC

Table of content: (NPI 1821105404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821105404 NPI number — KUSER PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUSER 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:
1821105404
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:
1544 KUSER ROAD
Provider Second Line Business Mailing Address:
SUITE C1
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-585-2200
Provider Business Mailing Address Fax Number:
609-585-2206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1544 KUSER ROAD
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-585-2200
Provider Business Practice Location Address Fax Number:
609-585-2206
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHETH
Authorized Official First Name:
AMARISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
609-585-2200

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: 01000219401 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K2758 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2697588 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5060907 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2144125001 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2144125001 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1047088 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30010052 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".




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