Provider Demographics
NPI:1346275849
Name:PEDIATRIC ASSOCIATES OF CENTRAL JERSEY PA
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF CENTRAL JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:V
Authorized Official - Last Name:SPANKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, OM
Authorized Official - Phone:732-767-0526
Mailing Address - Street 1:326 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2431
Mailing Address - Country:US
Mailing Address - Phone:732-767-0630
Mailing Address - Fax:732-767-3070
Practice Address - Street 1:326 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2431
Practice Address - Country:US
Practice Address - Phone:732-767-0630
Practice Address - Fax:732-767-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 39053208000000X
NJMA 48162208000000X
NJMA 48133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty