Healthcare Provider Details

I. General information

NPI: 1144489188
Provider Name (Legal Business Name): CENTRAL AVENUE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CENTRAL PARK AVE SUITE 102
SCARSDALE NY
10583-3242
US

IV. Provider business mailing address

1075 CENTRAL PARK AVE SUITE 102
SCARSDALE NY
10583-3242
US

V. Phone/Fax

Practice location:
  • Phone: 914-472-4300
  • Fax: 914-472-2489
Mailing address:
  • Phone: 914-472-4300
  • Fax: 914-472-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KENNETH SCHIFFER
Title or Position: PARTNER
Credential: MD
Phone: 914-472-4300