MEDICARE: KIDS CARE PEDIATRICS, 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	:	1619953981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS CARE PEDIATRICS, PA

Provider Business Mailing Address
First Line	:	22 NORTH FRANKLIN AVENUE
Second Line	:	2ND FLOOR
City	:	PLEASANTVILLE
State	:	NJ
Zip	:	08232
Country	:	US
Telephone Number	:	609-272-0655
Fax Number	:	609-272-9317

Provider Business Practice Location Address
First Line	:	6529 BLACK HORSE PK
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-4509
Country	:	US
Telephone Number	:	609-645-8500
Fax Number	:	609-645-2574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JON M REGIS
Credential	:	M.D.
Telephone Number	:	609-272-0655

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/30/2012

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