Provider Demographics
NPI:1801840533
Name:COLTS NECK PEDIATRICS, INC.
Entity type:Organization
Organization Name:COLTS NECK PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-683-0099
Mailing Address - Street 1:26 STATE ROUTE 34 S
Mailing Address - Street 2:STE 208
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1737
Mailing Address - Country:US
Mailing Address - Phone:732-683-0099
Mailing Address - Fax:732-683-9503
Practice Address - Street 1:26 STATE ROUTE 34 S
Practice Address - Street 2:STE 208
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1737
Practice Address - Country:US
Practice Address - Phone:732-683-0099
Practice Address - Fax:732-683-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty