Provider Demographics
NPI:1811361207
Name:HEALTHY KIDS PEDIATRICS, LLC
Entity Type:Organization
Organization Name:HEALTHY KIDS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:GARRIPOLI
Authorized Official - Last Name:PEDALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:844-437-5455
Mailing Address - Street 1:675 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1209
Mailing Address - Country:US
Mailing Address - Phone:844-437-5455
Mailing Address - Fax:862-238-7454
Practice Address - Street 1:675 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1209
Practice Address - Country:US
Practice Address - Phone:844-437-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07995400261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty