Healthcare Provider Details

I. General information

NPI: 1760077259
Provider Name (Legal Business Name): VERMENTON MOLINA PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 E GUN HILL RD
BRONX NY
10469-3010
US

IV. Provider business mailing address

1109 ADEE AVE
BRONX NY
10469-5117
US

V. Phone/Fax

Practice location:
  • Phone: 929-461-1538
  • Fax: 929-396-7296
Mailing address:
  • Phone: 929-385-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE DANIEL VERMENTON
Title or Position: OWNER
Credential: MD
Phone: 929-385-4299