Provider Demographics
NPI:1770668089
Name:FAMILY MEDICINE PEDIATRICS LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-678-2901
Mailing Address - Street 1:310 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2838
Mailing Address - Country:US
Mailing Address - Phone:973-678-2900
Mailing Address - Fax:973-678-8183
Practice Address - Street 1:310 CENTRAL AVENUE
Practice Address - Street 2:SUITE 305
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2838
Practice Address - Country:US
Practice Address - Phone:973-678-2900
Practice Address - Fax:973-678-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty