MEDICARE: FLORHAM PARK 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	261QP2300X	Primary Care Clinic/Center	065998	NJ

General Provider Information

NPI Number	:	1225406424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORHAM PARK PEDIATRICS

Provider Business Mailing Address
First Line	:	195 COLUMBIA TPKE
Second Line	:	SUITE 105
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-2254
Country	:	US
Telephone Number	:	973-437-8300
Fax Number	:	973-845-2883

Provider Business Practice Location Address
First Line	:	195 COLUMBIA TPKE
Second Line	:	SUITE 105
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-2254
Country	:	US
Telephone Number	:	973-437-8300
Fax Number	:	973-845-2883

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MAUREEN ELIZABETH BAXLEY
Credential	:	MD
Telephone Number	:	973-437-8300

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/04/2015

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