Provider Demographics
NPI:1184678864
Name:PEDIATRICIANS FOR EXCEPTIONAL CHILDREN
Entity type:Organization
Organization Name:PEDIATRICIANS FOR EXCEPTIONAL CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEDESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-782-3300
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:92 BRICK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2177
Practice Address - Country:US
Practice Address - Phone:856-782-3300
Practice Address - Fax:856-504-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026085Medicaid