Provider Demographics
NPI:1487863668
Name:CENTER FOR CHILDHOOD AND NEONATAL SURGERY
Entity Type:Organization
Organization Name:CENTER FOR CHILDHOOD AND NEONATAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:973-972-0212
Mailing Address - Street 1:79 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2414
Mailing Address - Country:US
Mailing Address - Phone:973-972-0212
Mailing Address - Fax:973-972-1204
Practice Address - Street 1:90 BERGEN ST. SUITE 7100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-0212
Practice Address - Fax:973-972-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00040000282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital