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General NPI Number Information
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NPI Number | 1710007695
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Entity Type | Organization
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Legal Business Name | MILLENNIUM PEDIATRIC CARE, PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 RIVERVIEW PLZ RIVERVIEW MEDICAL CENTER
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City | RED BANK
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State | NJ
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Zip | 07701-1864
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Country | US
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Telephone | 732-450-2801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6067
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City | FREEHOLD
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State | NJ
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Zip | 07728-6067
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Country | US
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Telephone | 732-450-2801
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIAZ ALI
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Credential | M.D
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Telephone | 732-450-2801
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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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