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General NPI Number Information
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NPI Number | 1518516814
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Entity Type | Organization
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Legal Business Name | MONDESTIN PEDIATRICS LLC
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 40 FULD ST STE 301
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City | TRENTON
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State | NJ
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Zip | 08638-5247
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Country | US
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Telephone | 609-989-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 40 FULD ST STE 301
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City | TRENTON
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State | NJ
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Zip | 08638-5247
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Country | US
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Telephone | 609-989-9125
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | KALYAN YAMIJALA
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Credential |
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Telephone | 732-925-7542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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