MEDICARE: WHOLE CHILD CENTER, LLC

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

General Provider Information

NPI Number	:	1639332885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE CHILD CENTER, LLC

Provider Business Mailing Address
First Line	:	690 KINDERKAMACK RD
Second Line	:	SUITE 102
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-634-1600
Fax Number	:	201-634-1606

Provider Business Practice Location Address
First Line	:	690 KINDERKAMACK RD
Second Line	:	SUITE 102
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-634-1600
Fax Number	:	201-634-1606

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE ROSEN
Credential	:	MD
Telephone Number	:	201-634-1600

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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