Organization
PROSPECT PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FIDELIS OKOH (EXECUTIVE DIRECTOR OPERATIONS)
(973) 356-1696
Entity
Organization
Contact information
Practice address
163 BELLEVILLE AVE, BELLEVILLE, NJ 07109-2437
(973) 302-4644
(973) 528-2242
Mailing address
P.O. BOX 1268, BLOOMFIELD, NJ 07003
(973) 356-1696
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/30/2014
Last updated
12/11/2014
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