Healthcare Provider Details

I. General information

NPI: 1770796914
Provider Name (Legal Business Name): MENDHAM PEDIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLD HILL RD SUITE 6B
MENDHAM NJ
07945-2015
US

IV. Provider business mailing address

5 COLD HILL RD SUITE 6B
MENDHAM NJ
07945-2015
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-1996
  • Fax:
Mailing address:
  • Phone: 973-543-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA52535
License Number StateNJ

VIII. Authorized Official

Name: DR. DEEPA SINGH MINHAS
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 973-543-1996