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General NPI Number Information
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NPI Number | 1780866129
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Entity Type | Organization
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Legal Business Name | PEDIATRICIAN IN MONROE
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 18 CENTRE DR SUITE 205
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City | MONROE
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State | NJ
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Zip | 08831-1501
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Country | US
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Telephone | 732-561-7810
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Fax | 732-631-0742
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Provider Business Mailing Address
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Address Line | 13 SUMMERFIELD DR
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City | MONROE
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State | NJ
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Zip | 08831-3275
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Country | US
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Telephone | 732-561-7810
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Fax | 732-631-0742
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | HANNA GEBRE MEDHIN
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Credential | M.D.
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Telephone | 732-561-7810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MA07639600
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License Number State | NJ
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