Provider Demographics
NPI:1477766137
Name:WHITEHORSE PEDIATRICS
Entity Type:Organization
Organization Name:WHITEHORSE PEDIATRICS
Other - Org Name:PARVIN ALIZADEH MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-585-1234
Mailing Address - Street 1:445 WHITE HORSE AVE
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1408
Mailing Address - Country:US
Mailing Address - Phone:609-585-1234
Mailing Address - Fax:609-585-1070
Practice Address - Street 1:445 WHITE HORSE AVE
Practice Address - Street 2:SUITE 204A
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1408
Practice Address - Country:US
Practice Address - Phone:609-585-1234
Practice Address - Fax:609-585-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06970700305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8312401Medicaid
NJ8312401Medicaid