Provider Demographics
NPI:1225163678
Name:HARRISON PEDIATRIC CARE CENTER, P.A.
Entity Type:Organization
Organization Name:HARRISON PEDIATRIC CARE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PONCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMIERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-484-2584
Mailing Address - Street 1:332 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1775
Mailing Address - Country:US
Mailing Address - Phone:973-484-2584
Mailing Address - Fax:973-484-9216
Practice Address - Street 1:332 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1775
Practice Address - Country:US
Practice Address - Phone:973-484-2584
Practice Address - Fax:973-484-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty