Healthcare Provider Details

I. General information

NPI: 1639398365
Provider Name (Legal Business Name): SPRING LAKE PEDIATRICS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 WARREN AVE
SPRING LAKE NJ
07762-2038
US

IV. Provider business mailing address

613 WARREN AVE
SPRING LAKE NJ
07762-2038
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-1444
  • Fax: 732-974-1140
Mailing address:
  • Phone: 732-974-1444
  • Fax: 732-974-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: TONI GAINOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-974-1444