Healthcare Provider Details

I. General information

NPI: 1912117599
Provider Name (Legal Business Name): PEDIATRIC AND ADOLESCENT ASSOCIATES OF CENTRAL NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERRINE ROAD
OLD BRIDGE NJ
08857-2878
US

IV. Provider business mailing address

100 PERRINE ROAD
OLD BRIDGE NJ
08857-2878
US

V. Phone/Fax

Practice location:
  • Phone: 732-316-0900
  • Fax: 731-316-0499
Mailing address:
  • Phone: 732-316-0900
  • Fax: 731-316-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBERT S SALSTON
Title or Position: PRESIDENT
Credential: MD
Phone: 732-316-0900