MEDICARE: WOODBURY PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician		NJ

General Provider Information

NPI Number	:	1043242092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBURY PEDIATRICS

Provider Business Mailing Address
First Line	:	307 GLASSBORO RD
Second Line	:
City	:	WOODBURY HEIGHTS
State	:	NJ
Zip	:	08097-1018
Country	:	US
Telephone Number	:	856-853-0848
Fax Number	:	856-853-1889

Provider Business Practice Location Address
First Line	:	307 GLASSBORO RD
Second Line	:
City	:	WOODBURY HEIGHTS
State	:	NJ
Zip	:	08097-1018
Country	:	US
Telephone Number	:	856-853-0848
Fax Number	:	856-853-1889

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE KING EPPLE JR.
Credential	:	MD
Telephone Number	:	856-853-0848

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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