Organization
PEDS 360 PLUS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHELLE ADEGBITE-MARAVENTANO MD (OWNER)
(267) 594-8734
Entity
Organization
Contact information
Practice address
361 HIGHLAND AVE STE 206, JENKINTOWN, PA 19046-2632
(267) 594-8734
(215) 886-2136
Mailing address
361 HIGHLAND AVE STE 206, JENKINTOWN, PA 19046-2632
(267) 594-8734
(215) 886-2136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
133V00000X
Registered Dietitian
—
—
208000000X
Pediatrics Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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