Provider Demographics
NPI:1720311855
Name:PEDIATRIC EDEN L.L.C.
Entity Type:Organization
Organization Name:PEDIATRIC EDEN L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-376-9000
Mailing Address - Street 1:241 MILLBURN AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-376-9000
Mailing Address - Fax:973-376-7610
Practice Address - Street 1:241 MILLBURN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1739
Practice Address - Country:US
Practice Address - Phone:973-376-9000
Practice Address - Fax:973-376-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072666261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care