Provider Demographics
NPI:1679659577
Name:NEWARK PEDIATRICS PA
Entity Type:Organization
Organization Name:NEWARK PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-738-4800
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:101 KELWAY PLAZA
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-738-4800
Mailing Address - Fax:302-738-8750
Practice Address - Street 1:314 EAST MAIN ST
Practice Address - Street 2:101 KELWAY PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-738-4800
Practice Address - Fax:302-738-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000808102Medicaid