Provider Demographics
NPI:1639335706
Name:KIDZ DOCTOR LLC
Entity Type:Organization
Organization Name:KIDZ DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-277-4480
Mailing Address - Street 1:11 OVERLOOK RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3581
Mailing Address - Country:US
Mailing Address - Phone:908-277-4480
Mailing Address - Fax:
Practice Address - Street 1:11 OVERLOOK RD STE 170
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3581
Practice Address - Country:US
Practice Address - Phone:908-277-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty