Healthcare Provider Details

I. General information

NPI: 1861700353
Provider Name (Legal Business Name): PM PEDIATRICS OF BAYSIDE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210-31 26TH AVENUE
BAYSIDE NY
11360-1949
US

IV. Provider business mailing address

1 HOLLOW LN STE 301
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 516-677-5437
  • Fax:
Mailing address:
  • Phone: 516-677-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN HANLY
Title or Position: DIRECTOR OF RCM OPERATIONS
Credential:
Phone: 516-207-7919