Provider Demographics
NPI:1770796914
Name:MENDHAM PEDIATRIC CARE LLC
Entity type:Organization
Organization Name:MENDHAM PEDIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MINHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-543-1996
Mailing Address - Street 1:5 COLD HILL RD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-2015
Mailing Address - Country:US
Mailing Address - Phone:973-543-1996
Mailing Address - Fax:
Practice Address - Street 1:5 COLD HILL RD
Practice Address - Street 2:SUITE 6B
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-2015
Practice Address - Country:US
Practice Address - Phone:973-543-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty