Healthcare Provider Details

I. General information

NPI: 1043242092
Provider Name (Legal Business Name): WOODBURY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 GLASSBORO RD
WOODBURY HEIGHTS NJ
08097-1018
US

IV. Provider business mailing address

307 GLASSBORO RD
WOODBURY HEIGHTS NJ
08097-1018
US

V. Phone/Fax

Practice location:
  • Phone: 856-853-0848
  • Fax: 856-853-1889
Mailing address:
  • Phone: 856-853-0848
  • Fax: 856-853-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAWRENCE KING EPPLE JR.
Title or Position: OWNER
Credential: MD
Phone: 856-853-0848