Provider Demographics
NPI:1922535558
Name:WELLNESSCARE PEDIATRICS LLC
Entity Type:Organization
Organization Name:WELLNESSCARE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-246-9799
Mailing Address - Street 1:6 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1030
Mailing Address - Country:US
Mailing Address - Phone:908-246-9799
Mailing Address - Fax:
Practice Address - Street 1:57 US HIGHWAY 46 STE 200
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-509-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-14
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty