Provider Demographics
NPI:1114936879
Name:OLD TAPPAN PEDIATRICS
Entity Type:Organization
Organization Name:OLD TAPPAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-666-1000
Mailing Address - Street 1:215 OLD TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7000
Mailing Address - Country:US
Mailing Address - Phone:201-666-1000
Mailing Address - Fax:201-666-7610
Practice Address - Street 1:215 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7000
Practice Address - Country:US
Practice Address - Phone:201-666-1000
Practice Address - Fax:201-666-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty