Healthcare Provider Details

I. General information

NPI: 1588816532
Provider Name (Legal Business Name): NORTHERN VALLEY PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 LIVINGSTON ST UNIT 204
NORWOOD NJ
07648-1344
US

IV. Provider business mailing address

463 LIVINGSTON ST UNIT 204
NORWOOD NJ
07648-1344
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-7377
  • Fax: 201-564-7379
Mailing address:
  • Phone: 201-564-7377
  • Fax: 201-564-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHILPA ASHOK PATEL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 201-564-7377