Provider Demographics
NPI:1558489781
Name:GARDEN STATE PEDIATRICS
Entity Type:Organization
Organization Name:GARDEN STATE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-581-5100
Mailing Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:BLDG D, SUITE 203
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3882
Mailing Address - Country:US
Mailing Address - Phone:609-581-5100
Mailing Address - Fax:609-581-5134
Practice Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BLDG D, SUITE 203
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3882
Practice Address - Country:US
Practice Address - Phone:609-581-5100
Practice Address - Fax:609-581-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB0701992080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty