Provider Demographics
NPI:1437175593
Name:PEDIATRIC ASSOCIATES OF SHREWSBURY
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF SHREWSBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-3280
Mailing Address - Street 1:175 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-741-3280
Mailing Address - Fax:732-741-9450
Practice Address - Street 1:175 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-741-3280
Practice Address - Fax:732-741-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2970007Medicaid
NJC52623Medicare UPIN