Organization
ALL STAR PEDIATRICS AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUCHI MEHTA MD (MEDICAL DIRECTOR)
(973) 743-1392
Entity
Organization
Contact information
Practice address
199 BROAD ST, SUITE 1B, BLOOMFIELD, NJ 07003-2635
(973) 743-1392
(973) 743-3707
Mailing address
199 BROAD ST, SUITE 1B, BLOOMFIELD, NJ 07003-2635
(973) 743-1392
(973) 743-3707
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA08474900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0287326
—
NJ
Enumeration date
08/07/2014
Last updated
08/07/2014
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