Healthcare Provider Details

I. General information

NPI: 1104937259
Provider Name (Legal Business Name): VINELAND PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 E CHESTNUT AVE #5B
VINELAND NJ
08360-5062
US

IV. Provider business mailing address

1138 E CHESTNUT AVE #5B
VINELAND NJ
08360-5062
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-1108
  • Fax: 856-692-2077
Mailing address:
  • Phone: 856-692-1108
  • Fax: 856-692-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DEBORAH L MCMASTER
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 856-692-1108