MEDICARE: VENTNOR PEDIATRICS INC

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	25MA06156800	NJ

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	:	1689961401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENTNOR PEDIATRICS INC

Provider Business Mailing Address
First Line	:	6601 VENTNOR AVE
Second Line	:	SUITE #14
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2167
Country	:	US
Telephone Number	:	609-487-6507
Fax Number	:	609-487-6508

Provider Business Practice Location Address
First Line	:	6601 VENTNOR AVE
Second Line	:	SUITE #14
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2167
Country	:	US
Telephone Number	:	609-487-6507
Fax Number	:	609-487-6508

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MRS. EMIOLA O ASEMOTA
Credential	:	M.D.
Telephone Number	:	609-487-6507

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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Directions to “VENTNOR PEDIATRICS INC ” Practice Location

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