Healthcare Provider Details

I. General information

NPI: 1316043151
Provider Name (Legal Business Name): INTERBORO PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2768 PITKIN AVE
BROOKLYN NY
11208-3239
US

IV. Provider business mailing address

2768 PITKIN AVE
BROOKLYN NY
11208-3239
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-7100
  • Fax: 718-235-7161
Mailing address:
  • Phone: 718-235-7100
  • Fax: 718-235-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number171076
License Number StateNY

VIII. Authorized Official

Name: DR. ERIC KRAUSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-235-7100