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General NPI Number Information
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NPI Number | 1124057203
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Entity Type | Organization
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Legal Business Name | DP PEDIATRICS LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 142 TOTOWA RD #8
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City | TOTOWA
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State | NJ
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Zip | 07512-2745
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Country | US
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Telephone | 973-904-1000
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Fax | 973-904-1480
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Provider Business Mailing Address
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Address Line | 142 TOTOWA RD #8
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City | TOTOWA
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State | NJ
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Zip | 07512-2745
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Country | US
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Telephone | 973-904-1000
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Fax | 973-904-1480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRATIBHA S DESHMUKH
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Credential | M.D.
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Telephone | 973-904-1000
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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 | 25MA 03456600
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License Number State | NJ
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