Healthcare Provider Details

I. General information

NPI: 1154711141
Provider Name (Legal Business Name): THE AMBOYS PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MCCLELLAN ST
PERTH AMBOY NJ
08861-4319
US

IV. Provider business mailing address

285 MCCLELLAN ST
PERTH AMBOY NJ
08861-4319
US

V. Phone/Fax

Practice location:
  • Phone: 973-458-8000
  • Fax: 973-458-8425
Mailing address:
  • Phone: 973-458-8000
  • Fax: 973-458-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: RAUL ALMANZAR
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 973-458-8000