Healthcare Provider Details

I. General information

NPI: 1013928126
Provider Name (Legal Business Name): HAMBURG PEDIATRIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VERNON AVE
HAMBURG NJ
07419-1153
US

IV. Provider business mailing address

2 VERNON AVE
HAMBURG NJ
07419-1195
US

V. Phone/Fax

Practice location:
  • Phone: 973-827-1918
  • Fax: 800-661-4832
Mailing address:
  • Phone: 973-827-1918
  • Fax: 800-661-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA073413
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID FRANCIS MARKEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-827-1918