Provider Demographics
NPI:1972565356
Name:PEDIATRICS OF SOUTH BRUNSWICK PA
Entity Type:Organization
Organization Name:PEDIATRICS OF SOUTH BRUNSWICK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-274-2727
Mailing Address - Street 1:395 RIDGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1398
Mailing Address - Country:US
Mailing Address - Phone:732-274-2727
Mailing Address - Fax:732-274-1662
Practice Address - Street 1:395 RIDGE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1398
Practice Address - Country:US
Practice Address - Phone:732-274-2727
Practice Address - Fax:732-274-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty