Healthcare Provider Details

I. General information

NPI: 1578891073
Provider Name (Legal Business Name): NEWYORK PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 MERRICK RD SUITE :305
BALDWIN NY
11510-3338
US

IV. Provider business mailing address

865 MERRICK RD SUITE :305
BALDWIN NY
11510-3338
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-6262
  • Fax:
Mailing address:
  • Phone: 516-546-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number116182
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1851439822
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. NIRMAL KUMAR KHURANA
Title or Position: MD
Credential: MD
Phone: 516-546-6262