Provider Demographics
NPI:1730328113
Name:PEDIATRIC PHYSICIAN CARE,LLC
Entity type:Organization
Organization Name:PEDIATRIC PHYSICIAN CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-617-1003
Mailing Address - Street 1:74 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9209
Mailing Address - Country:US
Mailing Address - Phone:732-617-1003
Mailing Address - Fax:732-617-1004
Practice Address - Street 1:74 ROUTE 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9209
Practice Address - Country:US
Practice Address - Phone:732-617-1003
Practice Address - Fax:732-617-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty