Provider Demographics
NPI:1689961401
Name:VENTNOR PEDIATRICS INC
Entity Type:Organization
Organization Name:VENTNOR PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMIOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ASEMOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-487-6507
Mailing Address - Street 1:6601 VENTNOR AVE
Mailing Address - Street 2:SUITE #14
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2167
Mailing Address - Country:US
Mailing Address - Phone:609-487-6507
Mailing Address - Fax:609-487-6508
Practice Address - Street 1:6601 VENTNOR AVE
Practice Address - Street 2:SUITE #14
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2167
Practice Address - Country:US
Practice Address - Phone:609-487-6507
Practice Address - Fax:609-487-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06156800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6482406Medicaid
NJG19624Medicare UPIN
NJ6482406Medicaid