Healthcare Provider Details

I. General information

NPI: 1649337171
Provider Name (Legal Business Name): SPRINGFIELD PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 ELMORA AVENUE
ELIZABETH NJ
07208
US

IV. Provider business mailing address

435 ELMORA AVENUE
ELIZABETH NJ
07208
US

V. Phone/Fax

Practice location:
  • Phone: 908-659-9200
  • Fax: 908-659-9210
Mailing address:
  • Phone: 908-659-9200
  • Fax: 908-659-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROLANDO LOZANO
Title or Position: OWNER
Credential: MD
Phone: 908-659-9200