Healthcare Provider Details

I. General information

NPI: 1124169727
Provider Name (Legal Business Name): WOODBRIDGE PEDIATRICS & ADOLESCENT CARE.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LAKE AVE
COLONIA NJ
07067-1323
US

IV. Provider business mailing address

80 LAKE AVE
COLONIA NJ
07067-1323
US

V. Phone/Fax

Practice location:
  • Phone: 732-396-4744
  • Fax: 732-396-9604
Mailing address:
  • Phone: 732-396-4744
  • Fax: 732-396-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA05905800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number25MA04259400
License Number StateNJ

VIII. Authorized Official

Name: MR. KAMAL P CHARAIPOTRA
Title or Position: PRESIDENT
Credential: MD
Phone: 732-396-0813