Provider Demographics
NPI:1629131651
Name:ADULT & PEDIATRIC ALLERGIST OF CENTRAL JERSEY PA
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC ALLERGIST OF CENTRAL JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-1920
Mailing Address - Street 1:1740 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2847
Mailing Address - Country:US
Mailing Address - Phone:732-321-1920
Mailing Address - Fax:732-906-1781
Practice Address - Street 1:1740 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2847
Practice Address - Country:US
Practice Address - Phone:732-321-1920
Practice Address - Fax:732-906-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1398300Medicaid
NJ066542Medicare ID - Type Unspecified