Provider Demographics
NPI:1225021181
Name:WATCHUNG PEDIATRICS
Entity Type:Organization
Organization Name:WATCHUNG PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-755-5437
Mailing Address - Street 1:76 STIRLING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5751
Mailing Address - Country:US
Mailing Address - Phone:908-755-5437
Mailing Address - Fax:908-755-6905
Practice Address - Street 1:76 STIRLING RD
Practice Address - Street 2:STE 201
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5751
Practice Address - Country:US
Practice Address - Phone:908-755-5437
Practice Address - Fax:908-755-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ956005OtherAMERIHEALTH PPO GROUP ID
NJ606914OtherPHCS GROUP ID
NJ1431OtherUNIVERSITY GROUP ID
NJ5149509Medicaid
NJ0376373001OtherAMERIHEALTH HMO GROUP ID
NJ0501095OtherAETNA HMO GROUP ID