Healthcare Provider Details

I. General information

NPI: 1396923223
Provider Name (Legal Business Name): ASSOCIATED PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W 9TH ST
PLAINFIELD NJ
07060-2426
US

IV. Provider business mailing address

203 W 9TH ST
PLAINFIELD NJ
07060-2426
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-5550
  • Fax: 908-756-3072
Mailing address:
  • Phone: 908-756-5550
  • Fax: 908-756-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA034270
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0966801
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. KARL E RUSSELL BROWN
Title or Position: DOCTOR
Credential: M.D.
Phone: 908-756-5550