Healthcare Provider Details

I. General information

NPI: 1275757916
Provider Name (Legal Business Name): MIDDLETOWN PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 HWY #35
RED BANK NJ
07701-5037
US

IV. Provider business mailing address

529 HWY #35
RED BANK NJ
07701-5037
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-9800
  • Fax: 732-758-6367
Mailing address:
  • Phone: 732-741-9800
  • Fax: 732-758-6367

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:

# 1
Identifier0600008
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier0882909
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
Identifier2905302
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MRS. KATHLEEN E READY
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-741-9800