Organization · NPI-2

Kidkare Medical PA

Clinic/Center · Fair Lawn, NJ

NPI number1386856029
StatusActive
Last updated in NPPESJun 23, 2016

Details

NPI
1386856029
Entity type
Organization (NPI-2)
Legal business name
Kidkare Medical PA
Organization subpart
No
Enumeration date
May 4, 2007
Last updated
Jun 23, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center25MA07639000NJYes

Practice location

15-01 Broadway Ste 36
Fair Lawn, NJ 07410-6006

Phone 201-773-6171 · Fax 201-773-4845

Mailing address

15-01 Broadway Ste 36
Fair Lawn, NJ 07410-6006

Phone 201-773-6171 · Fax 201-773-4845

Authorized official

Irina Bass
Pediatrician
2017736171

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