Healthcare Provider Details

I. General information

NPI: 1386883155
Provider Name (Legal Business Name): PEDIATRICS HEALTH ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD. SUITE 302
PLAINVIEW NY
11803
US

IV. Provider business mailing address

100 MANETTO HILL RD. SUITE 302
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-7337
  • Fax: 516-931-7444
Mailing address:
  • Phone: 516-931-7337
  • Fax: 516-931-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NANCY JO LIPPMAN
Title or Position: PARTNER
Credential: M.D.
Phone: 516-931-7377