Healthcare Provider Details

I. General information

NPI: 1588851331
Provider Name (Legal Business Name): MOUNT PLEASANT MEDICINE-PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 BENIC PL
HAWTHORNE NY
10532-1001
US

IV. Provider business mailing address

183 BENIC PL
HAWTHORNE NY
10532-1001
US

V. Phone/Fax

Practice location:
  • Phone: 914-769-8325
  • Fax: 914-769-8318
Mailing address:
  • Phone: 914-769-8325
  • Fax: 914-769-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNY225954
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225954
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH MIRAGLIA
Title or Position: PRESIDENT
Credential: MD
Phone: 914-769-8325