Provider Demographics
NPI:1639318371
Name:NEPTUNE PEDIATRICS LLC
Entity Type:Organization
Organization Name:NEPTUNE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-988-3336
Mailing Address - Street 1:1812 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4802
Mailing Address - Country:US
Mailing Address - Phone:732-988-3336
Mailing Address - Fax:732-776-8668
Practice Address - Street 1:1812 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4802
Practice Address - Country:US
Practice Address - Phone:732-988-3336
Practice Address - Fax:732-776-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB66764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7952601Medicaid