Provider Demographics
NPI:1326555749
Name:PEDIATRIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICJA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:UCZKOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-772-0262
Mailing Address - Street 1:54 PLAUDERVILLE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2252
Mailing Address - Country:US
Mailing Address - Phone:973-772-0262
Mailing Address - Fax:973-772-0265
Practice Address - Street 1:54 PLAUDERVILLE AVE STE 3
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2252
Practice Address - Country:US
Practice Address - Phone:973-772-0262
Practice Address - Fax:973-772-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07239500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty