Provider Demographics
NPI:1114071024
Name:SUSSEX COUNTY PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SUSSEX COUNTY PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-293-7579
Mailing Address - Street 1:2 MYRTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07827
Mailing Address - Country:US
Mailing Address - Phone:973-293-7579
Mailing Address - Fax:
Practice Address - Street 1:2 MYRTLE DRIVE
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:NJ
Practice Address - Zip Code:07827
Practice Address - Country:US
Practice Address - Phone:973-293-7579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty