Healthcare Provider Details

I. General information

NPI: 1720177553
Provider Name (Legal Business Name): THROGS NECK PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 E TREMONT AVE LOWER LEVEL
BRONX NY
10465-2032
US

IV. Provider business mailing address

3594 E TREMONT AVE LOWER LEVEL
BRONX NY
10465-2032
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-1050
  • Fax: 718-863-1895
Mailing address:
  • Phone: 718-863-1050
  • Fax: 718-863-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number138456
License Number StateNY

VIII. Authorized Official

Name: DR. LON B EASTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-863-1050