Healthcare Provider Details

I. General information

NPI: 1831379395
Provider Name (Legal Business Name): BEACH PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 LONG BEACH RD
ISLAND PARK NY
11558-1510
US

IV. Provider business mailing address

312 LONG BEACH RD
ISLAND PARK NY
11558-1510
US

V. Phone/Fax

Practice location:
  • Phone: 516-897-5000
  • Fax:
Mailing address:
  • Phone: 516-897-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number152926
License Number StateNY

VIII. Authorized Official

Name: BETH PISCITELLI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 516-897-5000