Provider Demographics
NPI:1235106212
Name:PEDIATRIC ASSOCIATES OF HOLMDEL,PC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF HOLMDEL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KUSUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-739-4414
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1522
Mailing Address - Country:US
Mailing Address - Phone:732-739-4414
Mailing Address - Fax:732-739-9537
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITE 1-E
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-739-4414
Practice Address - Fax:732-739-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty