Healthcare Provider Details

I. General information

NPI: 1235479544
Provider Name (Legal Business Name): CASIA PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CENTRAL AVE
JERSEY CITY NJ
07306-2126
US

IV. Provider business mailing address

67 CENTRAL AVE
JERSEY CITY NJ
07306-2126
US

V. Phone/Fax

Practice location:
  • Phone: 201-798-6161
  • Fax: 201-798-0432
Mailing address:
  • Phone: 201-798-6161
  • Fax: 201-798-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JEFFREY CASIA
Title or Position: OWNER
Credential: M.D.
Phone: 201-798-6161