Healthcare Provider Details

I. General information

NPI: 1225021181
Provider Name (Legal Business Name): WATCHUNG PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 STIRLING RD STE 201
WARREN NJ
07059-5751
US

IV. Provider business mailing address

76 STIRLING RD STE 201
WARREN NJ
07059-5751
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-5437
  • Fax: 908-755-6905
Mailing address:
  • Phone: 908-755-5437
  • Fax: 908-755-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREA G KATZ
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 908-755-5437