MYSTIC ISLAND PEDIATRIC ASSOCIATES, LLC (NPI# 1679892533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679892533 |
| Entity Type | Organization |
| Organization Name | MYSTIC ISLAND PEDIATRIC ASSOCIATES, LLC |
| Practice Address |
104 E Anchor Dr Little Egg Harbor Twp NJ 08087-1643 |
| Practice Telephone | 6092945500 |
| Practice Fax Number | 6092945700 |
| Mailing Telephone | 6092945500 |
| Mailing Fax Number | 6092945700 |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-05-18 |
| Authorized Official Name | DR. GENE CHIU LEE (VP) |
| Authorized Official Telephone | 6092945500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
25MA05073700 | NJ | Ambulatory Health Care Facilities |
| Street Address |
104 E ANCHOR DR |
| City | LITTLE EGG HARBOR TWP |
| State | NJ |
| Zip Code | 08087-1643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932610300 | Acme Markets Inc | Durable Medical Equipment & Medical Supplies | 425 Us 9, Tuckerton, NJ 08087 | 2017-10-12 |
| 1679083877 | Tiffany Wild | Speech-Language Pathologist | 324 Frog Pond Rd, Little Egg Harbor Township, NJ 08087 | 2017-10-03 |
| 1124570098 | Dana Nicole Luciano | Physician Assistant | 798 County Road #539, #3, Little Egg Harbor Township, NJ 08087 | 2016-10-26 |
| 1235598616 | Ocean Health Initiatives,inc | General Practice | 798 County Road 539, Little Egg Harbor, NJ 08087 | 2016-02-15 |
| 1093159253 | Terraces At Seacrest Village LLC | Assisted Living Facility | 281 Mathistown Road, Little Egg Harbor Township, NJ 08087 | 2013-04-18 |
| 1023390762 | Gerri Hoegler | Counselor | 1064 S. Main St. Unit 206, West Creek, NJ 08087 | 2011-09-19 |
| 1437366572 | Walgreens Pharmacy | Pharmacy | 201 Mathistown Road, Little Egg Harbor, NJ 08087 | 2007-05-17 |
| 1669599957 | Paul Damian Lauria | Chiropractor | 871 Radio Rd, Little Egg Harbor, NJ 08087 | 2007-03-23 |
| 1528196276 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 201 Mathistown Rd, Little Egg Harbor Twp, NJ 08087 | 2007-03-02 |
| 1083752216 | Mystic Pharmacy Inc | Pharmacy | 972 Radio Rd, Little Egg Harbor, NJ 08087 | 2007-02-01 |
| Find all providers in zip 08087 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1578129490 | Beaute Medispa, LLC | Clinic/Center | 195 Route 9 Ste 101, Manalapan, NJ 07726-8294 | 2019-05-16 |
| 1437627023 | Point Pediatrics | Clinic/Center | 800 Route 88 Ste 3, Point Pleasant Boro, NJ 08742-4085 | 2018-11-13 |
| 1770067126 | Skin Cancer and Cosmetic Surgery Center of New Jersey, LLC | Clinic/Center | 10 Parsonage Rd Ste 312, Edison, NJ 08837-2429 | 2018-09-21 |
| 1780165100 | Renew Med Spa and Clinic LLC | Clinic/Center | 601 Hamburg Tpke Ste 101, Wayne, NJ 07470-2049 | 2018-08-23 |
| 1497243232 | Tristate Multispecialty Medical Services PC | Clinic/Center | 126 State St Fl 1, Hackensack, NJ 07601-5448 | 2018-04-26 |
| 1285136226 | Robinson-gallaro Gi Health & Solutions | Clinic/Center | 717 N Beers St Ste 2c, Holmdel, NJ 07733-1525 | 2018-03-06 |
| 1821505462 | Integrative Wellness & Cosmetics, Inc | Clinic/Center | 601 9th St, Hoboken, NJ 07030-6428 | 2018-01-04 |
| 1356850671 | Nj Allergy & Asthma Care LLC | Clinic/Center | 26 Parker Rd, Edison, NJ 08820 | 2017-09-29 |
| Find all providers with the same taxonomy | ||||
| City | LITTLE EGG HARBOR TWP |
| Zip Code | 08087 |
Please comment or provide details below to improve the information on MYSTIC ISLAND PEDIATRIC ASSOCIATES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.