Provider Demographics
NPI:1891097721
Name:PISCATAWAY PEDIATRICS
Entity Type:Organization
Organization Name:PISCATAWAY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-834-8534
Mailing Address - Street 1:1140 STELTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5202
Mailing Address - Country:US
Mailing Address - Phone:908-834-8534
Mailing Address - Fax:
Practice Address - Street 1:1140 STELTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5202
Practice Address - Country:US
Practice Address - Phone:908-834-8534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08120400261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care