Healthcare Provider Details

I. General information

NPI: 1780709113
Provider Name (Legal Business Name): SHORT HILLS PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 COLUMBIA TPKE SUITE 201
FLORHAM PARK NJ
07932-2240
US

IV. Provider business mailing address

29 COLUMBIA TPKE SUITE 201
FLORHAM PARK NJ
07932-2240
US

V. Phone/Fax

Practice location:
  • Phone: 973-410-0422
  • Fax:
Mailing address:
  • Phone: 973-410-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05662700
License Number StateNJ

VIII. Authorized Official

Name: DR. MOJGAN BEHBAKHT
Title or Position: OWNER
Credential: M.D.
Phone: 973-410-0422