Provider Demographics
NPI:1881756922
Name:WESTSIDE PEDIATRICS,P.A.
Entity type:Organization
Organization Name:WESTSIDE PEDIATRICS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:BAUTISTA
Authorized Official - Last Name:MESINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-432-0714
Mailing Address - Street 1:2749 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5540
Mailing Address - Country:US
Mailing Address - Phone:201-432-0714
Mailing Address - Fax:
Practice Address - Street 1:2749 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5540
Practice Address - Country:US
Practice Address - Phone:201-432-0714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6186106Medicaid
NJ6224903Medicaid
NJ6186301Medicaid
NJAS620353Medicare ID - Type UnspecifiedDR. CLARO M. ASPREC
NJ6186106Medicaid
NJF99156Medicare UPIN
NJMA620354Medicare ID - Type UnspecifiedDR. TAYYABA MALIK
NJ6224903Medicaid
NJ6186301Medicaid