Healthcare Provider Details

I. General information

NPI: 1114191608
Provider Name (Legal Business Name): BASKING RIDGE PEDIATRIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N FINLEY AVE
BASKING RIDGE NJ
07920-1686
US

IV. Provider business mailing address

150 N FINLEY AVE
BASKING RIDGE NJ
07920-1686
US

V. Phone/Fax

Practice location:
  • Phone: 908-766-4660
  • Fax: 908-204-9871
Mailing address:
  • Phone: 908-766-4660
  • Fax: 908-204-9871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA02405700
License Number StateNJ

VIII. Authorized Official

Name: HENRY J KIM
Title or Position: OWNER
Credential: M.D.
Phone: 908-766-4600