Healthcare Provider Details

I. General information

NPI: 1881181220
Provider Name (Legal Business Name): BABY DOCTOR (NJ) LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W 80TH ST STE 214
NEW YORK NY
10024-6370
US

IV. Provider business mailing address

180 W 80TH ST STE 214
NEW YORK NY
10024-6370
US

V. Phone/Fax

Practice location:
  • Phone: 800-315-2229
  • Fax: 212-937-3992
Mailing address:
  • Phone: 800-315-2229
  • Fax: 212-937-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09855900
License Number StateNJ

VIII. Authorized Official

Name: DANIA RUMBAK
Title or Position: MAJORITY MEMBER
Credential: M.D.
Phone: 800-315-2229