Provider Demographics
NPI:1740230952
Name:VENTNOR PEDIATRICS INC.
Entity Type:Organization
Organization Name:VENTNOR PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMIOLA
Authorized Official - Middle Name:
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
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2167
Mailing Address - Country:US
Mailing Address - Phone:609-487-6509
Mailing Address - Fax:609-487-6508
Practice Address - Street 1:6601 VENTNOR AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:VENTNOR
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:2006-05-10
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0294497Medicaid
NJ2255928001OtherAMERIHEALTH HMO/PPO
NJ=========OtherTAX ID