Provider Demographics
NPI:1558325274
Name:GLOUCESTER COUNTY PEDIATRICS
Entity Type:Organization
Organization Name:GLOUCESTER COUNTY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:N
Authorized Official - Last Name:COANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-848-6346
Mailing Address - Street 1:849 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2571
Mailing Address - Country:US
Mailing Address - Phone:856-848-6346
Mailing Address - Fax:
Practice Address - Street 1:849 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2571
Practice Address - Country:US
Practice Address - Phone:856-848-6346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty