Provider Demographics
NPI:1609990043
Name:PEDIATRIC URGICARE LLC
Entity Type:Organization
Organization Name:PEDIATRIC URGICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-918-1666
Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3570
Mailing Address - Country:US
Mailing Address - Phone:908-918-1666
Mailing Address - Fax:908-918-9449
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-918-1666
Practice Address - Fax:908-918-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty