Provider Demographics
NPI:1366502189
Name:BROADWAY PEDIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:BROADWAY PEDIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-664-7444
Mailing Address - Street 1:336 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1702
Mailing Address - Country:US
Mailing Address - Phone:201-664-7444
Mailing Address - Fax:201-664-8610
Practice Address - Street 1:336 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1702
Practice Address - Country:US
Practice Address - Phone:201-664-7444
Practice Address - Fax:201-664-8610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCD HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3277801Medicaid