Provider Demographics
NPI:1770250383
Name:PREVENTATIVE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:PREVENTATIVE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-219-5110
Mailing Address - Street 1:450 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3274
Mailing Address - Country:US
Mailing Address - Phone:609-219-5110
Mailing Address - Fax:609-498-7254
Practice Address - Street 1:450 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3274
Practice Address - Country:US
Practice Address - Phone:609-219-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1770841322OtherNPI