| Peds 360 Plus Corp | |
|
361 Highland Ave Ste 206 Jenkintown PA 19046-2632 | |
| (267) 594-8734 | |
| (215) 886-2136 |
| Full Name | Peds 360 Plus Corp |
|---|---|
| Speciality | Pediatrics |
| Location | 361 Highland Ave Ste 206, Jenkintown, Pennsylvania |
| Authorized Official Name and Position | Nichelle Adegbite-maraventano (OWNER) |
| Authorized Official Contact | 2675948734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peds 360 Plus Corp 361 Highland Ave Ste 206 Jenkintown PA 19046-2632 Ph: (267) 594-8734 | Peds 360 Plus Corp 361 Highland Ave Ste 206 Jenkintown PA 19046-2632 Ph: (267) 594-8734 |
| NPI Number | 1730940263 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/22/2024 |
| Medicare PECOS PAC ID | 9234676784 |
|---|---|
| Medicare Enrollment ID | O20240801004641 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730940263 | NPI | - | NPPES |
| Provider Name | Nichelle Adegbite-maraventano |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891003208 PECOS PAC ID: 8123262011 Enrollment ID: I20130916000188 |
| Provider Name | Jasmine A Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144712258 PECOS PAC ID: 4587912183 Enrollment ID: I20180730001253 |
| Provider Name | Ebony L Holloway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376268086 PECOS PAC ID: 1254878549 Enrollment ID: I20240805001578 |
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