Healthcare Provider Details

I. General information

NPI: 1093770901
Provider Name (Legal Business Name): PATRICIA CREMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-00 RT 208 S MAPLE AVE PEDIATRICS
FAIRLAWN NJ
07410
US

IV. Provider business mailing address

23-00 RT 208 S MAPLE AVE PEDIATRICS
FAIRLAWN NJ
07410
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-1900
  • Fax: 201-797-4457
Mailing address:
  • Phone: 201-797-1900
  • Fax: 201-797-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA55663
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: