Healthcare Provider Details

I. General information

NPI: 1447674981
Provider Name (Legal Business Name): TRIBECA PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SUNSET BLVD TRIBECA PEDIATRICS
LOS ANGELES CA
90026
US

IV. Provider business mailing address

11 PARK PL SUITE 1200
NEW YORK NY
10007-2801
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-7666
  • Fax:
Mailing address:
  • Phone: 212-226-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC127654
License Number StateCA

VIII. Authorized Official

Name: LESLIE PENNYPACKER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 212-226-7666