Organization
ETHEL AND RAPHAEL PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUKEMI OMOTOSO MD (OWNER)
(732) 531-2200
Entity
Organization
Contact information
Practice address
1405 HIGHWAY 35, SUITE 104, OCEAN, NJ 07712-3532
(732) 531-2200
(732) 531-2900
Mailing address
1405 HIGHWAY 35, SUITE 104, OCEAN, NJ 07712-3532
(732) 531-2200
(732) 531-2900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA07961200
NJ
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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