Provider Demographics
NPI:1770090037
Name:PEDIATRIC ENDOCRINOLOGY ASSOCIATES
Entity type:Organization
Organization Name:PEDIATRIC ENDOCRINOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-871-4680
Mailing Address - Street 1:2 DEAN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2870
Mailing Address - Country:US
Mailing Address - Phone:201-871-4680
Mailing Address - Fax:201-871-3815
Practice Address - Street 1:2 DEAN DR STE 2
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2870
Practice Address - Country:US
Practice Address - Phone:201-871-4680
Practice Address - Fax:201-871-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10140100261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679866255OtherUHC, OXFORD, AETNA, HORIZON, CIGNA, AMERIHEALTH