Provider Demographics
NPI:1497026793
Name:PRINCETON PEDIATRICS, PA
Entity type:Organization
Organization Name:PRINCETON PEDIATRICS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-290-3344
Mailing Address - Street 1:4804 EDGEWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1126
Mailing Address - Country:US
Mailing Address - Phone:407-290-3344
Mailing Address - Fax:877-767-4236
Practice Address - Street 1:4804 EDGEWATER DR STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1126
Practice Address - Country:US
Practice Address - Phone:407-290-3344
Practice Address - Fax:877-767-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123233500Medicaid
FL804240OtherBLUE CROSS BLUE SHEILD