Provider Demographics
NPI:1104853100
Name:MOORESTOWN PEDIATRICS, LLP
Entity Type:Organization
Organization Name:MOORESTOWN PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:TIANGCO
Authorized Official - Last Name:GUEVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-235-0264
Mailing Address - Street 1:703 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3082
Mailing Address - Country:US
Mailing Address - Phone:856-235-0264
Mailing Address - Fax:856-235-4635
Practice Address - Street 1:703 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3082
Practice Address - Country:US
Practice Address - Phone:856-235-0264
Practice Address - Fax:856-235-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04812299261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care