1851523674 NPI number — ADVANCED PEDIATRICS GROUP, L.L.C.

Table of content: (NPI 1851523674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851523674 NPI number — ADVANCED PEDIATRICS GROUP, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PEDIATRICS GROUP, L.L.C.
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:
1851523674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 RIVER RD APT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NUTLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07110-3465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SUMMIT AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-8503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-407-9421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DOS SANTOS
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CO OWNER
Authorized Official Telephone Number:
201-407-9421

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25MA07427800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1093740458 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com