Healthcare Provider Details

I. General information

NPI: 1922184985
Provider Name (Legal Business Name): WOODBURY PEDIATRICS ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TERMINAL DR STE 2
PLAINVIEW NY
11803-2312
US

IV. Provider business mailing address

202 TERMINAL DR. STE 2
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-0202
  • Fax: 516-576-8872
Mailing address:
  • Phone: 516-576-0202
  • Fax: 516-576-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. HEDDY J ZIRIN
Title or Position: PARTNER
Credential: M.D.
Phone: 516-576-0202