Healthcare Provider Details

I. General information

NPI: 1679659577
Provider Name (Legal Business Name): NEWARK PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 EAST MAIN ST 101 KELWAY PLAZA
NEWARK DE
19711
US

IV. Provider business mailing address

314 E MAIN ST 101 KELWAY PLAZA
NEWARK DE
19711
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-4800
  • Fax: 302-738-8750
Mailing address:
  • Phone: 302-738-4800
  • Fax: 302-738-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JENIFER FIORAVANTI
Title or Position: OFFICE BUSINESS MANAGER
Credential:
Phone: 302-738-4800