Healthcare Provider Details

I. General information

NPI: 1811014483
Provider Name (Legal Business Name): PEDIATRICS 2000AT 207 STREET PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 207TH ST
NEW YORK NY
10034-2645
US

IV. Provider business mailing address

515 W 207TH ST
NEW YORK NY
10034-2645
US

V. Phone/Fax

Practice location:
  • Phone: 212-544-7777
  • Fax: 212-544-9660
Mailing address:
  • Phone: 212-544-7777
  • Fax: 212-544-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JUAN TAPIA MENDOZA
Title or Position: OWNER
Credential: MD
Phone: 212-544-7777