Healthcare Provider Details

I. General information

NPI: 1679521504
Provider Name (Legal Business Name): PEDIATRIC SPECIALTY GROUP AT THE AMBULATORY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

PO BOX 18456
NEWARK NJ
07191-8456
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7623
  • Fax: 973-322-7698
Mailing address:
  • Phone: 732-557-7160
  • Fax: 732-557-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY ESPOSITO
Title or Position: DIRECTOR
Credential:
Phone: 732-557-7160