Provider Demographics
NPI:1811019995
Name:PEDIATRICS ON BROADWAY
Entity Type:Organization
Organization Name:PEDIATRICS ON BROADWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-625-7734
Mailing Address - Street 1:10 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2704
Mailing Address - Country:US
Mailing Address - Phone:973-625-7734
Mailing Address - Fax:973-625-4821
Practice Address - Street 1:10 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2704
Practice Address - Country:US
Practice Address - Phone:973-625-7734
Practice Address - Fax:973-625-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty