Healthcare Provider Details

I. General information

NPI: 1184847188
Provider Name (Legal Business Name): LAMINGTON PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROSPECT AVE, 1C
HACKENSACK NJ
07601
US

IV. Provider business mailing address

304 SOUTH DR
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-5018
  • Fax: 201-487-5020
Mailing address:
  • Phone: 201-487-5018
  • Fax: 201-487-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA67533
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8274509
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. PURNACHANDER R SIRIKONDA
Title or Position: DOCTOR
Credential: M.D.,
Phone: 201-487-5018