Healthcare Provider Details

I. General information

NPI: 1891903837
Provider Name (Legal Business Name): BROADWAY PEDIATRICS M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 BROADWAY SUITE 1C
NEW YORK NY
10033-3748
US

IV. Provider business mailing address

4250 BROADWAY SUITE 1C
NEW YORK NY
10033-3748
US

V. Phone/Fax

Practice location:
  • Phone: 212-740-3900
  • Fax: 212-740-8232
Mailing address:
  • Phone: 212-740-3900
  • Fax: 212-740-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. JOSE PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-740-3900