MEDICARE: PEDIATRICIANS FOR EXCEPTIONAL CHILDREN

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	2080P0006X	Developmental - Behavioral Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184678864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICIANS FOR EXCEPTIONAL CHILDREN

Provider Business Mailing Address
First Line	:	402 LIPPINCOTT DR
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4112
Country	:	US
Telephone Number	:	856-782-3300
Fax Number	:	856-504-8029

Provider Business Practice Location Address
First Line	:	92 BRICK RD
Second Line	:	2ND FLOOR
City	:	MARLTON
State	:	NJ
Zip	:	08053-2177
Country	:	US
Telephone Number	:	856-782-3300
Fax Number	:	856-504-8029

Authorized Official
Title or Position	:	CEO/ CHAIRMAN
Name	:	DR. JOHN M TEDESCHI
Credential	:	MD
Telephone Number	:	856-782-3300

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/04/2010

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Directions to “PEDIATRICIANS FOR EXCEPTIONAL CHILDREN ” Practice Location

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