| Kidkare Medical Pa | |
|
15-01 Broadway Ste 36 Fair Lawn NJ 07410-6006 | |
| (201) 773-6171 | |
| (201) 773-4845 |
| Full Name | Kidkare Medical Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 15-01 Broadway Ste 36, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Irina Bass (PEDIATRICIAN) |
| Authorized Official Contact | 2017736171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidkare Medical Pa 15-01 Broadway Ste 36 Fair Lawn NJ 07410-6006 Ph: (201) 773-6171 | Kidkare Medical Pa 15-01 Broadway Ste 36 Fair Lawn NJ 07410-6006 Ph: (201) 773-6171 |
| NPI Number | 1386856029 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 06/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386856029 | NPI | - | NPPES |
| 0081787 | Medicaid | NJ | |
| 1346212156 | Other | NJ | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 25MA07639000 (New Jersey) | Primary |
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