Provider Demographics
NPI:1265859094
Name:AVENUE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:AVENUE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIGOS-COSTEAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-228-6302
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-228-6302
Mailing Address - Fax:973-228-6305
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-228-6302
Practice Address - Fax:973-228-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty