Provider Demographics
NPI:1134248073
Name:EDISON PEDIATRICS LLC
Entity type:Organization
Organization Name:EDISON PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-452-9800
Mailing Address - Street 1:3 STATE ROUTE 27 STE 301
Mailing Address - Street 2:COLONIAL VILLAGE SHOPPING COMPLEX
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3963
Mailing Address - Country:US
Mailing Address - Phone:732-452-9800
Mailing Address - Fax:
Practice Address - Street 1:3 STATE ROUTE 27 STE 301
Practice Address - Street 2:COLONIAL VILLAGE SHOPPING COMPLEX
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3963
Practice Address - Country:US
Practice Address - Phone:732-452-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5403901Medicaid