Healthcare Provider Details

I. General information

NPI: 1659401370
Provider Name (Legal Business Name): VALLEY PEDIATRIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST FRANKLIN TPKE
HO HO KUS NJ
07423-1515
US

IV. Provider business mailing address

201 E FRANKLIN TPKE
HO HO KUS NJ
07423-1515
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-1888
  • Fax: 201-652-6485
Mailing address:
  • Phone: 201-652-1888
  • Fax: 201-652-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: STEVEN J SHEVELEV
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 201-652-1888