Provider Demographics
NPI:1235208026
Name:THE PEDIATRIC GROUP, PA
Entity Type:Organization
Organization Name:THE PEDIATRIC GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TESORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-924-4892
Mailing Address - Street 1:281 WITHERSPOON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-924-4892
Mailing Address - Fax:609-921-9380
Practice Address - Street 1:281 WITHERSPOON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-924-4892
Practice Address - Fax:609-921-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty