MEDICARE: TRIBECA PEDIATRICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C127654	CA

General Provider Information

NPI Number	:	1447674981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBECA PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	11 PARK PL
Second Line	:	SUITE 1200
City	:	NEW YORK
State	:	NY
Zip	:	10007-2801
Country	:	US
Telephone Number	:	212-226-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 SUNSET BLVD
Second Line	:	TRIBECA PEDIATRICS
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:	212-226-7666
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	LESLIE PENNYPACKER
Credential	:
Telephone Number	:	212-226-7666

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/10/2016

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