Healthcare Provider Details

I. General information

NPI: 1346275849
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF CENTRAL JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 MAIN ST
METUCHEN NJ
08840-2431
US

IV. Provider business mailing address

326 MAIN ST
METUCHEN NJ
08840-2431
US

V. Phone/Fax

Practice location:
  • Phone: 732-767-0630
  • Fax: 732-767-3070
Mailing address:
  • Phone: 732-767-0630
  • Fax: 732-767-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA 39053
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA 48133
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA 48162
License Number StateNJ

VIII. Authorized Official

Name: MRS. JANET V SPANKO
Title or Position: OFFICE MANAGER
Credential: RN, OM
Phone: 732-767-0526