Healthcare Provider Details

I. General information

NPI: 1821369422
Provider Name (Legal Business Name): WARREN PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MOUNTAIN BLVD BLDG A SUITE 130
WARREN NJ
07059-2640
US

IV. Provider business mailing address

PO BOX 4584
WARREN NJ
07059-0584
US

V. Phone/Fax

Practice location:
  • Phone: 908-490-0900
  • Fax: 908-490-0910
Mailing address:
  • Phone: 908-490-0900
  • Fax: 908-490-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25 MA07409200
License Number StateNJ

VIII. Authorized Official

Name: DR. VASAVI PARIKH
Title or Position: OWNER
Credential: M.D.
Phone: 908-490-0900