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HOLMDEL PEDIATRICS LLC NPI 1760618383


NPI Information

NPI: 1760618383
Provider Name: HOLMDEL PEDIATRICS, LLC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
719 N BEERS ST
SUITE 1E
HOLMDEL, NJ
ZIP 07733
Phone: (732) 290-1063
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HOLMDEL PEDIATRICS, LLC is an adolescent medicine pediatrics in Holmdel, NJ. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. HOLMDEL PEDIATRICS, LLC NPI is 1760618383. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

719 N BEERS ST
SUITE 1E
HOLMDEL, NJ
ZIP 07733-522
Phone: (732) 290-1063
Fax: (732) 739-9537

The provider's authorized official is Sowmini Kommireddi .
The authorized official title is President and has the following contact phone number (732) 290-1063.

The enumeration date for this NPI number is 6/10/2009 and was last updated on 6/10/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080A0000XPediatricsAdolescent Medicine25MA073809NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11518064260OTHERNEW JERSEYNPI
29078502MEDICAIDNEW JERSEY
31154462604OTHERNEW JERSEYNPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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