Provider Demographics
NPI:1669444204
Name:MTM PEDIATRICS, LLC
Entity Type:Organization
Organization Name:MTM PEDIATRICS, LLC
Other - Org Name:STEPPING STONE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:MICALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-280-6455
Mailing Address - Street 1:3350 HIGHWAY 138
Mailing Address - Street 2:BUILDING 2, SUITE 126
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9693
Mailing Address - Country:US
Mailing Address - Phone:732-280-6455
Mailing Address - Fax:732-280-6456
Practice Address - Street 1:3350 HIGHWAY 138
Practice Address - Street 2:BUILDING 2, SUITE 126
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9693
Practice Address - Country:US
Practice Address - Phone:732-280-6455
Practice Address - Fax:732-280-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty