Provider Demographics
NPI:1386865772
Name:TRINITY PEDIATRICS, LLC
Entity Type:Organization
Organization Name:TRINITY PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIA
Authorized Official - Middle Name:CALHOUN
Authorized Official - Last Name:GRUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-810-8551
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE B218
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-810-8551
Mailing Address - Fax:908-810-8661
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE B218
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-810-8551
Practice Address - Fax:908-810-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA70103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty