Healthcare Provider Details

I. General information

NPI: 1154388403
Provider Name (Legal Business Name): WILLOWBROOK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WILLOWBROOK BLVD SUITE 421
WAYNE NJ
07470-7045
US

IV. Provider business mailing address

57 WILLOWBROOK BLVD SUITE 421
WAYNE NJ
07470-7045
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-4025
  • Fax: 973-754-4044
Mailing address:
  • Phone: 973-754-4025
  • Fax: 973-754-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PAPADOPOULOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-754-4025