Provider Demographics
NPI:1013928126
Name:HAMBURG PEDIATRIC CENTER LLC
Entity Type:Organization
Organization Name:HAMBURG PEDIATRIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-827-1918
Mailing Address - Street 1:2 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1195
Mailing Address - Country:US
Mailing Address - Phone:973-827-1918
Mailing Address - Fax:800-661-4832
Practice Address - Street 1:2 VERNON AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1153
Practice Address - Country:US
Practice Address - Phone:973-827-1918
Practice Address - Fax:800-661-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073413208000000X
2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty