Basic Information
| Provider Information | |||||||||
| NPI: | 1790814127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC CARE PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 ROUTE 88 STE 2A | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087243229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328990008 | ||||||||
| FaxNumber: | 7328990447 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 ROUTE 88 STE 2A | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087243229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328990008 | ||||||||
| FaxNumber: | 7328990447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLLADO | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7328990008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MA070911 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.