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General NPI Number Information
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NPI Number | 1770090037
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINOLOGY ASSOCIATES
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 2 DEAN DR STE 2
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City | TENAFLY
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State | NJ
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Zip | 07670-2870
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Country | US
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Telephone | 201-871-4680
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Fax | 201-871-3815
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Provider Business Mailing Address
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Address Line | 2 DEAN DR STE 2
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City | TENAFLY
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State | NJ
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Zip | 07670-2870
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Country | US
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Telephone | 201-871-4680
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Fax | 201-871-3815
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ELIZABETH BURTMAN
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Credential | MD
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Telephone | 201-871-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA10140100
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License Number State | NJ
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