Provider Demographics
NPI:1134280043
Name:PEDIATRIC AND ADOLESCENT MEDICINE GROUP NJ
Entity Type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT MEDICINE GROUP NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGLIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-374-8446
Mailing Address - Street 1:400 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3910
Mailing Address - Country:US
Mailing Address - Phone:856-374-8446
Mailing Address - Fax:856-232-9291
Practice Address - Street 1:400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3910
Practice Address - Country:US
Practice Address - Phone:856-374-8446
Practice Address - Fax:856-232-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty