Provider Demographics
NPI:1639251804
Name:QUALITY CARE PEDIATRIX
Entity type:Organization
Organization Name:QUALITY CARE PEDIATRIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AAD DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IBILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGHAMA-AMEGOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-926-4400
Mailing Address - Street 1:88 CHANCELLOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112
Mailing Address - Country:US
Mailing Address - Phone:973-926-4400
Mailing Address - Fax:973-926-4660
Practice Address - Street 1:88 CHANCELLOR AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:973-926-4400
Practice Address - Fax:973-926-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6467105Medicaid
NJ6467105Medicaid