Healthcare Provider Details

I. General information

NPI: 1609245315
Provider Name (Legal Business Name): ROBBINSVILLE AND BORDENTOWN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CROSSWICKS RD STE 11
BORDENTOWN NJ
08505-2602
US

IV. Provider business mailing address

30 BELMONT CIR
COLUMBUS NJ
08022-9714
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-7204
  • Fax: 609-298-0491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PRATHIBHA POTHARLANKA
Title or Position: PRESIDEBT
Credential: M.D.
Phone: 856-465-7728