Healthcare Provider Details

I. General information

NPI: 1679974760
Provider Name (Legal Business Name): PREMIER PEDIATRICS CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 FULTON AVE
HEMPSTEAD NY
11550-3651
US

IV. Provider business mailing address

72 FULTON AVE
HEMPSTEAD NY
11550-3651
US

V. Phone/Fax

Practice location:
  • Phone: 516-564-2056
  • Fax:
Mailing address:
  • Phone: 516-564-2056
  • Fax: 516-564-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number237804
License Number StateNY

VIII. Authorized Official

Name: DR. TANYA ELEANOR DUVIVIER
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 51656542056