Healthcare Provider Details

I. General information

NPI: 1700956927
Provider Name (Legal Business Name): PEDIACARE PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 E 14TH STREET SUITE 108
BROOKLYN NY
11229
US

IV. Provider business mailing address

1636 E 14TH STREET SUITE 108
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-6425
  • Fax: 718-376-6427
Mailing address:
  • Phone: 718-376-6425
  • Fax: 718-376-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149049
License Number StateNY

VIII. Authorized Official

Name: EDWARD J GINDI
Title or Position: OWNER
Credential:
Phone: 718-376-6425