Healthcare Provider Details

I. General information

NPI: 1891942967
Provider Name (Legal Business Name): PEDIATRIC PROFESSIONAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 RATZER RD SUITE D-20
WAYNE NJ
07470
US

IV. Provider business mailing address

330 RATZER RD SUITE D-20
WAYNE NJ
07470-7702
US

V. Phone/Fax

Practice location:
  • Phone: 973-835-5556
  • Fax: 973-696-0226
Mailing address:
  • Phone: 973-835-5556
  • Fax: 973-696-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY TURSO
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-835-5556