MEDICARE: PEDIATRIC HEALTH, PA

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	208000000X	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	:	1518077445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HEALTH, PA

Provider Business Mailing Address
First Line	:	69 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2114
Country	:	US
Telephone Number	:	732-409-3633
Fax Number	:	732-409-7133

Provider Business Practice Location Address
First Line	:	4537 ROUTE 9 NORTH
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3380
Country	:	US
Telephone Number	:	732-367-5715
Fax Number	:	732-367-6524

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	ROBERTA LOPEZ
Credential	:
Telephone Number	:	732-780-3333

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/16/2011

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Directions to “PEDIATRIC HEALTH, PA ” Practice Location

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