Healthcare Provider Details

I. General information

NPI: 1912039074
Provider Name (Legal Business Name): PEDIATRICS 2000 II PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 150TH ST STE 1
NEW YORK NY
10031-2428
US

IV. Provider business mailing address

600 W 150TH ST STE 1
NEW YORK NY
10031-2428
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-2000
  • Fax:
Mailing address:
  • Phone: 212-694-2000
  • Fax:

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
Title or Position: OWNER
Credential: M.D
Phone: 212-694-2000