Provider Demographics
NPI:1225406424
Name:FLORHAM PARK PEDIATRICS
Entity Type:Organization
Organization Name:FLORHAM PARK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-437-8300
Mailing Address - Street 1:195 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2254
Mailing Address - Country:US
Mailing Address - Phone:973-437-8300
Mailing Address - Fax:973-845-2883
Practice Address - Street 1:195 COLUMBIA TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2254
Practice Address - Country:US
Practice Address - Phone:973-437-8300
Practice Address - Fax:973-845-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ065998261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care