Provider Demographics
NPI:1609227248
Name:ESSEX PEDIATRICS & ASSOCIATES PC
Entity Type:Organization
Organization Name:ESSEX PEDIATRICS & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:ESQUERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-412-7700
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0529
Mailing Address - Country:US
Mailing Address - Phone:973-412-7700
Mailing Address - Fax:973-412-7703
Practice Address - Street 1:654 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3110
Practice Address - Country:US
Practice Address - Phone:973-412-7700
Practice Address - Fax:973-412-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03786800305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0459208Medicaid