Provider Demographics
NPI:1609128719
Name:BERNARDSVILLE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BERNARDSVILLE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKODIJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-766-5960
Mailing Address - Street 1:40 MORRISTOWN RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2310
Mailing Address - Country:US
Mailing Address - Phone:908-766-5960
Mailing Address - Fax:
Practice Address - Street 1:40 MORRISTOWN RD STE 2D
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2310
Practice Address - Country:US
Practice Address - Phone:908-766-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07685300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty