Provider Demographics
NPI:1093777476
Name:SOL PEDIATRICS LLC
Entity Type:Organization
Organization Name:SOL PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGA
Authorized Official - Middle Name:SOL
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-725-8308
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0746
Mailing Address - Country:US
Mailing Address - Phone:201-689-1939
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17
Practice Address - Street 2:SUITE 302
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2809
Practice Address - Country:US
Practice Address - Phone:201-689-1939
Practice Address - Fax:201-689-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07800500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty