Healthcare Provider Details

I. General information

NPI: 1255675393
Provider Name (Legal Business Name): IPEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BOWLING GREEN PKWY SUITE 202
LAKE HOPATCONG NJ
07849-3200
US

IV. Provider business mailing address

21 BOWLING GREEN PKWY SUITE 202
LAKE HOPATCONG NJ
07849-3200
US

V. Phone/Fax

Practice location:
  • Phone: 973-663-1143
  • Fax:
Mailing address:
  • Phone: 973-663-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN DEPUYT
Title or Position: PARTNER/CO-OWNER
Credential: APN
Phone: 973-663-1143