Healthcare Provider Details

I. General information

NPI: 1306922992
Provider Name (Legal Business Name): SOMERSET PEDIATRIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 ROUTE 28 STE 2100
RARITAN NJ
08869-1363
US

IV. Provider business mailing address

575 ROUTE 28 STE 2205
RARITAN NJ
08869-1363
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-1802
  • Fax: 908-203-8825
Mailing address:
  • Phone: 908-725-5530
  • Fax: 908-253-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLY PARLAVECCHIO
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: RN
Phone: 908-725-5530