Provider Demographics
NPI:1558451492
Name:PEDIATRIC ASSOCIATES OF ATLANTIC COUNTY
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF ATLANTIC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-823-2773
Mailing Address - Street 1:9009 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2444
Mailing Address - Country:US
Mailing Address - Phone:909-823-2773
Mailing Address - Fax:609-823-6464
Practice Address - Street 1:9009 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2444
Practice Address - Country:US
Practice Address - Phone:909-823-2773
Practice Address - Fax:609-823-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA3883900261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2636107Medicaid
NJ2636107Medicaid