Organization
PEDIARIC CENTER 2000 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESUS RUBEN ORTEGA MD (PRESIDENT)
(973) 484-5401
Entity
Organization
Contact information
Practice address
571 N 6TH ST, NEWARK, NJ 07107-2501
(973) 485-5401
(973) 485-1536
Mailing address
1079 PLEASANT VALLEY WAY, WEST ORANGE, NJ 07052-1418
(973) 485-5401
(973) 485-1536
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
25MA06060600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6164102
—
NJ
Enumeration date
04/03/2009
Last updated
04/03/2009
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