Healthcare Provider Details

I. General information

NPI: 1962532010
Provider Name (Legal Business Name): WEST ORANGE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 NORTHFIELD AVE
WEST ORANGE NJ
07052-5342
US

IV. Provider business mailing address

81 NORTHFIELD AVE
WEST ORANGE NJ
07052-5342
US

V. Phone/Fax

Practice location:
  • Phone: 973-324-5437
  • Fax: 973-324-0356
Mailing address:
  • Phone: 973-324-5437
  • Fax: 973-324-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA62740
License Number StateNJ

VIII. Authorized Official

Name: DR. ABRAHAM THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 973-324-5437