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General NPI Number Information
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NPI Number | 1659401370
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Entity Type | Organization
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Legal Business Name | VALLEY PEDIATRIC ASSOCIATES PA
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 EAST FRANKLIN TPKE
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City | HO HO KUS
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State | NJ
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Zip | 07423-1515
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Country | US
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Telephone | 201-652-1888
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Fax | 201-652-6485
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Provider Business Mailing Address
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Address Line | 201 EAST FRANKLIN TPKE
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City | HO HO KUS
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State | NJ
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Zip | 07423-1515
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Country | US
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Telephone | 201-652-1888
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Fax | 201-652-6485
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRENE SHEVELEV
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Credential | MD
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Telephone | 201-652-1888
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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 | NJ
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