Provider Demographics
NPI:1669635520
Name:HAMILTON PEDIATRICS PA
Entity Type:Organization
Organization Name:HAMILTON PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-625-8585
Mailing Address - Street 1:5401 HARDING HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2243
Mailing Address - Country:US
Mailing Address - Phone:609-625-8585
Mailing Address - Fax:609-625-3415
Practice Address - Street 1:5401 HARDING HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2243
Practice Address - Country:US
Practice Address - Phone:609-625-8585
Practice Address - Fax:609-625-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05306600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3450503Medicaid