Healthcare Provider Details

I. General information

NPI: 1760666036
Provider Name (Legal Business Name): PEDIATRIC CENTER OF SOMERSET LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 HOW LN STE 2F
NORTH BRUNSWICK NJ
08902-4600
US

IV. Provider business mailing address

PO BOX 6086
SOMERSET NJ
08875-6086
US

V. Phone/Fax

Practice location:
  • Phone: 732-764-0004
  • Fax: 732-960-2301
Mailing address:
  • Phone: 732-764-0004
  • Fax: 732-658-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW JAY SPEESLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-764-0004