Healthcare Provider Details

I. General information

NPI: 1174723191
Provider Name (Legal Business Name): PREMIER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE SUITE 4H
BROOKLYN NY
11215-3689
US

IV. Provider business mailing address

263 7TH AVE SUITE 4H
BROOKLYN NY
11215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-0817
  • Fax: 718-369-1253
Mailing address:
  • Phone: 718-369-0817
  • Fax: 718-369-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CARESA OSBORN
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-369-0817