Healthcare Provider Details

I. General information

NPI: 1255596391
Provider Name (Legal Business Name): HJD PEDIATRICS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

380 2ND AVE ROOM 636
NEW YORK NY
10010-5615
US

V. Phone/Fax

Practice location:
  • Phone: 212-460-0110
  • Fax: 212-460-0160
Mailing address:
  • Phone: 212-460-0110
  • Fax: 212-460-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOIS S HALBER
Title or Position: BILLING MANAGER
Credential: RHIA
Phone: 212-460-0110