Provider Demographics
NPI:1588848212
Name:CANDLEWOOD PEDIATRICS & ADOLESCENT MEDICINE,PC
Entity Type:Organization
Organization Name:CANDLEWOOD PEDIATRICS & ADOLESCENT MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-370-9600
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:300 CANDLEWOOD COMMONS
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-0577
Mailing Address - Country:US
Mailing Address - Phone:732-370-9600
Mailing Address - Fax:732-370-9656
Practice Address - Street 1:300 CANDLEWOOD COMMONS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2170
Practice Address - Country:US
Practice Address - Phone:732-370-9600
Practice Address - Fax:732-370-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA049581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3460703Medicaid