Provider Demographics
NPI:1225768104
Name:KINDER PEDIATRIC CARE LLC
Entity Type:Organization
Organization Name:KINDER PEDIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-371-4400
Mailing Address - Street 1:65 RT 1 SOUTH
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840
Mailing Address - Country:US
Mailing Address - Phone:732-371-4400
Mailing Address - Fax:732-527-0397
Practice Address - Street 1:65 RT 1 SOUTH
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-371-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care