Healthcare Provider Details

I. General information

NPI: 1639335706
Provider Name (Legal Business Name): KIDZ DOCTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 OVERLOOK RD STE 170
SUMMIT NJ
07901-3581
US

IV. Provider business mailing address

11 OVERLOOK RD STE 170
SUMMIT NJ
07901-3581
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-4480
  • Fax:
Mailing address:
  • Phone: 908-277-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM ROY
Title or Position: MGR
Credential:
Phone: 908-277-4480