Healthcare Provider Details

I. General information

NPI: 1609019975
Provider Name (Legal Business Name): MIGUELINO AND DAVID PEDIATRIC ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N BEERS ST SUITE 1-F
HOLMDEL NJ
07733-1524
US

IV. Provider business mailing address

717 N BEERS ST SUITE 1-F
HOLMDEL NJ
07733-1524
US

V. Phone/Fax

Practice location:
  • Phone: 732-888-0777
  • Fax: 732-888-0880
Mailing address:
  • Phone: 732-888-0777
  • Fax: 732-888-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BERNADETTE MIGUELINO
Title or Position: MEMBER
Credential: MD
Phone: 732-888-0777