Provider Demographics
NPI:1912108507
Name:WESTPARK PEDIATRICS, LLP
Entity Type:Organization
Organization Name:WESTPARK PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:732-531-0010
Mailing Address - Street 1:804 W PARK AVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7272
Mailing Address - Country:US
Mailing Address - Phone:732-531-0010
Mailing Address - Fax:732-493-0903
Practice Address - Street 1:804 W PARK AVE
Practice Address - Street 2:BLDG B
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7272
Practice Address - Country:US
Practice Address - Phone:732-531-0010
Practice Address - Fax:732-493-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3193101Medicaid