Provider Demographics
NPI:1790036929
Name:PEDIATRIC SPECIALTY CARE SERVCES, LLC
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY CARE SERVCES, LLC
Other - Org Name:HOPE PEDIATRICS MEDICAL DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-730-1980
Mailing Address - Street 1:130 WASHINGTON CROSSING PE RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2508
Mailing Address - Country:US
Mailing Address - Phone:609-730-1980
Mailing Address - Fax:
Practice Address - Street 1:61 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3456
Practice Address - Country:US
Practice Address - Phone:609-730-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ080192261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care