Provider Demographics
NPI:1790814127
Name:PEDIATRIC CARE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC CARE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-899-0008
Mailing Address - Street 1:2211 ROUTE 88 STE 2A
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3229
Mailing Address - Country:US
Mailing Address - Phone:732-899-0008
Mailing Address - Fax:732-899-0447
Practice Address - Street 1:2211 ROUTE 88 STE 2A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3229
Practice Address - Country:US
Practice Address - Phone:732-899-0008
Practice Address - Fax:732-899-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty