Healthcare Provider Details

I. General information

NPI: 1144380759
Provider Name (Legal Business Name): HEALTHY KIDS PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B PRINCETON-HIGHTSTOWN ROAD SUITE 201
HIGHTSTOWN NJ
08520
US

IV. Provider business mailing address

300B PRINCETON-HIGHTSTOWN ROAD SUITE 201
HIGHTSTOWN NJ
08520
US

V. Phone/Fax

Practice location:
  • Phone: 609-448-7300
  • Fax: 609-448-8022
Mailing address:
  • Phone: 609-448-7300
  • Fax: 609-448-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. UTPAL S SHAH
Title or Position: CFO,COO
Credential: M.D
Phone: 609-448-7300