Organization
NEW JERSEY PEDIATRIC AND ADOLESCENT CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA M CHARLES MD (OWNER)
(973) 276-1140
Entity
Organization
Contact information
Practice address
1680 ROUTE 23, SUITE 350, WAYNE, NJ 07470-7501
(973) 521-9700
Mailing address
4 FOX HOLLOW RD, MONTVILLE, NJ 07045-9300
(973) 276-1140
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
25MA06235800
NJ
Other
Enumeration date
09/29/2013
Last updated
09/29/2013
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