Provider Demographics
NPI:1245652338
Name:LIVE WELL PEDIATRICS, PC
Entity type:Organization
Organization Name:LIVE WELL PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:POSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-612-5100
Mailing Address - Street 1:171 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1849
Mailing Address - Country:US
Mailing Address - Phone:201-612-5100
Mailing Address - Fax:
Practice Address - Street 1:171 FRANKLIN TPKE
Practice Address - Street 2:SUITE 110
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1849
Practice Address - Country:US
Practice Address - Phone:201-612-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06910400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty