Healthcare Provider Details

I. General information

NPI: 1174851265
Provider Name (Legal Business Name): SUNRISE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 02/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 PARSIPPANY RD SUITE 2A
PARSIPPANY NJ
07054-5102
US

IV. Provider business mailing address

99 GATHERINGHILL CT
MORRIS PLAINS NJ
07950-1190
US

V. Phone/Fax

Practice location:
  • Phone: 973-240-7436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08272000
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: VARSHABEN PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 973-240-7436