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General NPI Number Information
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NPI Number | 1043507270
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Entity Type | Organization
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Legal Business Name | MEJIA PEDIATRICS LLC
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 433 N BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07208-3300
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Country | US
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Telephone | 908-436-1002
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Fax | 908-436-1109
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Provider Business Mailing Address
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Address Line | 433 N BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07208-3300
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Country | US
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Telephone | 908-436-1002
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Fax | 908-436-1109
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Authorized Official
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Title or Position | OWNER
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Name | JOHANNA J GONZALEZ MEJIA
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Credential |
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Telephone | 908-436-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1428465
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License Number State | NJ
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