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General NPI Number Information
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NPI Number | 1639335706
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Entity Type | Organization
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Legal Business Name | KIDZ DOCTOR LLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 11 OVERLOOK RD STE 170
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City | SUMMIT
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State | NJ
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Zip | 07901-3581
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Country | US
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Telephone | 908-277-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 11 OVERLOOK RD STE 170
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City | SUMMIT
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State | NJ
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Zip | 07901-3581
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Country | US
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Telephone | 908-277-4480
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | WILLIAM ROY
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Credential |
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Telephone | 908-277-4480
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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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