MEDICARE: SOHO PEDIATRIC GROUP

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

General Provider Information

NPI Number	:	1508137290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOHO PEDIATRIC GROUP

Provider Business Mailing Address
First Line	:	552 BROADWAY
Second Line	:	5N
City	:	NEW YORK
State	:	NY
Zip	:	10012-3922
Country	:	US
Telephone Number	:	212-334-3366
Fax Number	:	212-334-3981

Provider Business Practice Location Address
First Line	:	552 BROADWAY
Second Line	:	5N
City	:	NEW YORK
State	:	NY
Zip	:	10012-3922
Country	:	US
Telephone Number	:	212-334-3366
Fax Number	:	212-334-3981

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBERT SAKEN
Credential	:	MD
Telephone Number	:	212-334-3366

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	01/26/2012

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Directions to “SOHO PEDIATRIC GROUP ” Practice Location

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