Healthcare Provider Details

I. General information

NPI: 1922191311
Provider Name (Legal Business Name): PEDIATRIC STATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 GRAND CONCOURSE
BRONX NY
10458
US

IV. Provider business mailing address

PO BOX 518
BRONXVILLE NY
10708-0518
US

V. Phone/Fax

Practice location:
  • Phone: 718-329-2275
  • Fax: 718-329-2276
Mailing address:
  • Phone: 718-239-2275
  • Fax: 718-329-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANASTASSIOS KYRIAKAKOS
Title or Position: PRESIDENT
Credential: MD
Phone: 718-329-2275