Provider Demographics
NPI:1164461695
Name:NEXT GENERATION PEDIATRICS LLC
Entity Type:Organization
Organization Name:NEXT GENERATION PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEPFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-482-2220
Mailing Address - Street 1:100 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1792
Mailing Address - Country:US
Mailing Address - Phone:724-482-2220
Mailing Address - Fax:724-482-4466
Practice Address - Street 1:100 TECHNOLOGY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1792
Practice Address - Country:US
Practice Address - Phone:724-482-2220
Practice Address - Fax:724-482-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008350940001Medicaid
PAH96594Medicare UPIN
PA1008350940001Medicaid