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General NPI Number Information
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NPI Number | 1336411958
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Entity Type | Organization
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Legal Business Name | PEDSGASTRO CENTER LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 2123 KLOCKNER RD
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City | HAMILTON
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State | NJ
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Zip | 08690-3417
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Country | US
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Telephone | 609-586-7337
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Fax | 609-586-7338
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Provider Business Mailing Address
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Address Line | 15 LYNCH RD
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City | VOORHEES
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State | NJ
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Zip | 08043-4116
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Country | US
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Telephone | 856-874-6500
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Fax | 856-874-0512
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Authorized Official
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Title or Position | OWNER
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Name | SABEENA FARHATH
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Credential | MD
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Telephone | 856-874-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 25MA08176100
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License Number State | NJ
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