Provider Demographics
NPI:1316178601
Name:WOODBURY PEDIATRICS, LLC
Entity Type:Organization
Organization Name:WOODBURY PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIANTEDOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-853-0848
Mailing Address - Street 1:307 GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1018
Mailing Address - Country:US
Mailing Address - Phone:856-853-0848
Mailing Address - Fax:856-853-1889
Practice Address - Street 1:307 GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1018
Practice Address - Country:US
Practice Address - Phone:856-853-0848
Practice Address - Fax:856-853-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty