Provider Demographics
NPI:1538289038
Name:PEDIATRIC CLINIC OF NORTH JERSEY
Entity Type:Organization
Organization Name:PEDIATRIC CLINIC OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICISIMA
Authorized Official - Middle Name:GABATIN
Authorized Official - Last Name:BARRERA-TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-792-3022
Mailing Address - Street 1:3524 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3448
Mailing Address - Country:US
Mailing Address - Phone:201-792-3022
Mailing Address - Fax:
Practice Address - Street 1:3524 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3448
Practice Address - Country:US
Practice Address - Phone:201-792-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04592000261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care