Provider Demographics
NPI:1336284744
Name:PEDIATRIC ASSOCIATES OF WESTFIELD
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF WESTFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-233-7171
Mailing Address - Street 1:566 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3312
Mailing Address - Country:US
Mailing Address - Phone:908-233-7171
Mailing Address - Fax:908-233-2255
Practice Address - Street 1:566 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3312
Practice Address - Country:US
Practice Address - Phone:908-233-7171
Practice Address - Fax:908-233-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04943400305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization