Provider Demographics
NPI:1083629869
Name:BELLEVUE PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:BELLEVUE PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:609-989-9801
Mailing Address - Street 1:416 BELLEVUE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4513
Mailing Address - Country:US
Mailing Address - Phone:609-989-9801
Mailing Address - Fax:609-613-9755
Practice Address - Street 1:416 BELLEVUE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4513
Practice Address - Country:US
Practice Address - Phone:609-989-9801
Practice Address - Fax:609-613-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8276609Medicaid