Healthcare Provider Details

I. General information

NPI: 1982604302
Provider Name (Legal Business Name): NEW BRUNSWICK PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOW LN
NORTH BRUNSWICK NJ
08902-1721
US

IV. Provider business mailing address

PO BOX 6017 1300 HOW LANE
NORTH BRUNSWICK NJ
08902-6017
US

V. Phone/Fax

Practice location:
  • Phone: 732-247-1510
  • Fax: 732-247-8885
Mailing address:
  • Phone: 732-247-1510
  • Fax: 732-247-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HOWARD ERNEST WIENER
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 732-247-1510