Provider Demographics
NPI:1235665639
Name:SOL PEDIATRICS PC
Entity Type:Organization
Organization Name:SOL PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-423-1392
Mailing Address - Street 1:1030 LAFAYETTE AVE EXT
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2210
Mailing Address - Country:US
Mailing Address - Phone:973-423-1392
Mailing Address - Fax:
Practice Address - Street 1:490 HENDRICKS CSWY
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2115
Practice Address - Country:US
Practice Address - Phone:973-423-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09921400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty