Provider Demographics
NPI:1912117599
Name:PEDIATRIC AND ADOLESCENT ASSOCIATES OF CENTRAL NJ
Entity Type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT ASSOCIATES OF CENTRAL NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-316-0900
Mailing Address - Street 1:100 PERRINE ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2878
Mailing Address - Country:US
Mailing Address - Phone:732-316-0900
Mailing Address - Fax:731-316-0499
Practice Address - Street 1:100 PERRINE ROAD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2878
Practice Address - Country:US
Practice Address - Phone:732-316-0900
Practice Address - Fax:731-316-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE29948Medicare UPIN