MEDICARE: JERSEY CITY PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	MA41101	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861660219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERSEY CITY PEDIATRICS

Provider Business Mailing Address
First Line	:	1 JOURNAL SQUARE PLZ
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4004
Country	:	US
Telephone Number	:	201-963-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 JOURNAL SQUARE PLZ
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4004
Country	:	US
Telephone Number	:	201-963-0090
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. BANDANA RAHA
Credential	:	M.D.
Telephone Number	:	201-963-0090

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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Directions to “JERSEY CITY PEDIATRICS ” Practice Location

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