Healthcare Provider Details

I. General information

NPI: 1114064110
Provider Name (Legal Business Name): CHILTON PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CHILTON STREET CHILTON PEDIATRICS LLC
ELIZABETH NJ
07202-1448
US

IV. Provider business mailing address

144 CHILTON STREET CHILTON PEDIATRICS LLC
ELIZABETH NJ
07202-1448
US

V. Phone/Fax

Practice location:
  • Phone: 908-659-0429
  • Fax: 908-659-1559
Mailing address:
  • Phone: 908-659-0429
  • Fax: 908-659-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA57959
License Number StateNJ

VIII. Authorized Official

Name: DANILO MAGALLANES GUINTO
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 908-659-0429