Provider Demographics
NPI:1275757916
Name:MIDDLETOWN PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:MIDDLETOWN PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:READY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-741-9800
Mailing Address - Street 1:529 HWY #35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5037
Mailing Address - Country:US
Mailing Address - Phone:732-741-9800
Mailing Address - Fax:732-758-6367
Practice Address - Street 1:529 HWY #35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5037
Practice Address - Country:US
Practice Address - Phone:732-741-9800
Practice Address - Fax:732-758-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0600008Medicaid
NJ0882909Medicaid
NJ2905302Medicaid
NJ0882909Medicaid
NJC62880Medicare UPIN