Provider Demographics
NPI:1780709113
Name:SHORT HILLS PEDIATRICS, INC.
Entity type:Organization
Organization Name:SHORT HILLS PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-410-0422
Mailing Address - Street 1:29 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2240
Mailing Address - Country:US
Mailing Address - Phone:973-410-0422
Mailing Address - Fax:
Practice Address - Street 1:29 COLUMBIA TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2240
Practice Address - Country:US
Practice Address - Phone:973-410-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05662700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE39374Medicare UPIN