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General NPI Number Information
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NPI Number | 1013928126
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Entity Type | Organization
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Legal Business Name | HAMBURG PEDIATRIC CENTER LLC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 2 VERNON AVE
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City | HAMBURG
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State | NJ
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Zip | 07419-1153
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Country | US
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Telephone | 973-827-1918
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Fax | 800-661-4832
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Provider Business Mailing Address
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Address Line | 2 VERNON AVE
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City | HAMBURG
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State | NJ
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Zip | 07419-1195
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Country | US
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Telephone | 973-827-1918
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Fax | 800-661-4832
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID FRANCIS MARKEL
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Credential | M.D.
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Telephone | 973-827-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA073413
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License Number State | NJ
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