Provider Demographics
NPI:1144380759
Name:HEALTHY KIDS PEDIATRIC GROUP
Entity Type:Organization
Organization Name:HEALTHY KIDS PEDIATRIC GROUP
Other - Org Name:EAST WINDSOR PEDIATRIC GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO,COO
Authorized Official - Prefix:DR
Authorized Official - First Name:UTPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-448-7300
Mailing Address - Street 1:300B PRINCETON-HIGHTSTOWN ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-448-7300
Mailing Address - Fax:609-448-8022
Practice Address - Street 1:300B PRINCETON-HIGHTSTOWN ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-448-7300
Practice Address - Fax:609-448-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty