Provider Demographics
NPI:1639386956
Name:PEDIAHEALTH MEDICAL ASSOCIATES,PA
Entity Type:Organization
Organization Name:PEDIAHEALTH MEDICAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:CALIMLIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-722-5444
Mailing Address - Street 1:720 US HIGHWAY 202-206 NORTH
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-722-5444
Mailing Address - Fax:908-722-5071
Practice Address - Street 1:720 US HIGHWAY 202-206 NORTH
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-722-5444
Practice Address - Fax:908-722-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04868100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty