Organization
PEDORTHIC CONCEPTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA DEQUEIROZ (OFFICE MGR)
(732) 341-6262
Entity
Organization
Contact information
Practice address
145 ATLANTIC CITY BLVD, BEACHWOOD, NJ 08722
(732) 341-6262
(732) 341-5464
Mailing address
145 ATLANTIC CITY BLVD, BEACHWOOD, NJ 08722
(732) 341-6262
(732) 341-5464
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62714
AMERIGROUP
NJ
05
—
7830505
—
NJ
Enumeration date
11/28/2006
Last updated
10/21/2008
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