# STC PEDIATRICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Christopher's Pediatric Associates General Surgery - Sewell
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417591645
- **Authorized official:** BRIAN RAYME (EVP & CFO)
- **Authorized official phone:** (484) 628-1324

## Contact information

- **Practice address:** 100 KINGS WAY E STE C, SEWELL, NJ 08080-2238
- **Practice address phone:** (215) 427-5292
- **Mailing address:** PO BOX 13579, READING, PA 19612-3579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2019
- **Last updated:** 11/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0721212 | — | NJ |