Provider Demographics
NPI:1316184112
Name:PARAMUS PEDIATRICS, PA
Entity Type:Organization
Organization Name:PARAMUS PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-712-1599
Mailing Address - Street 1:22 MADISON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2721
Mailing Address - Country:US
Mailing Address - Phone:201-712-1599
Mailing Address - Fax:201-712-7996
Practice Address - Street 1:22 MADISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2721
Practice Address - Country:US
Practice Address - Phone:201-712-1599
Practice Address - Fax:201-712-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 71301261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8480401Medicaid