Healthcare Provider Details

I. General information

NPI: 1831379841
Provider Name (Legal Business Name): UNION COUNTY PEDIATRICS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 RAHWAY AVE
ELIZABETH NJ
07202-2212
US

IV. Provider business mailing address

817 RAHWAY AVE
ELIZABETH NJ
07202-2212
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-5750
  • Fax: 908-349-3064
Mailing address:
  • Phone: 908-353-5750
  • Fax: 908-349-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03959800
License Number StateNJ

VIII. Authorized Official

Name: MR. VISHAL GANDHI
Title or Position: MANAGER
Credential:
Phone: 908-353-5750